THE  REPORT  OF  THE 
PHILADELPHIA  BABY 
SAVINC;   SHOW        1912 


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Foreivord 


Knowledge  is  waste,  unless  knowledge  saves.  Humanitj'  is  the  measure  of 
scientific  discovery.     Unless  the  many  learn,  the  few  teach  in  vain. 

The  Philadelpiiia  Baby  Saving  Show  lived  all  tliis.  It  sought  to  bring  the 
newest  fact  in  medicine  near  the  newest  baby.  It  brought  science  to  worship  the 
babe  in  arms, and  most  of  all  the  babe  for  whom  "there  was  no  room  in  the  inn," the 
inn  of  all  the  world  in  which  the  best  rooms  are  taken  by  the  old  and  advantaged, 
which  are  the  past,  and  the  babe,  which  is  the  future,  is  brought  forth  to  pay  the 
heavy  tax  of  death,  laid  by  a  decree  greater  than  Caesar's,  through  which  all  the 
world  is  indeed  at  last  taxed,  but  the  babe  first  and  most  of  all. 

Not  all  babies.  Even  this  tax  of  death  laid  on  babies  can  be  commuted  by 
care  and  knowledge.  The  death  of  the  old  is  inevitable  and  in  the  course  of  nature. 
The  death  of  babies  is  social  murder  and  in  the  course  and  carelessness  of  man. 
Educate  the  mother,  and  the  baby  will  have  life  more  abundantly.  Given  perfect 
conditions,  or  at  least  as  perfect  as  our  known  knowledge  now  permits,  and  not  one 
baby  in  an  hundred  would  die,  as  a  baby.  Years  later,  age  would  end.  Now, 
babyhood  slays.  Leave  conditions  as  they  are  and  twenty  or  twenty-five  out  of  an 
hundred  babies  die. 

The  fight  for  babies  is  in  most  cities  the  fight  for  a  quarter  of  tho.sc  born. 
No  one  can  win  this  fight  but  the  mother.  Add  to  her  love,  knowledge,  and  to  her 
knowledge,  instruction,  and  to  instruction,  practice,  and  a  place  in  a  mother's 
arms  would  be  the  safest  of  all  refuges.  Today  society  slays  one  in  four  babies 
in  their  mothers'  arms.  It  is  the  most  unsafe  refuge  known.  No  other  part  of 
society  dies  as  much  as  babies. 

The  Baby  Saving  Show  in  Philadelphia  was  an  effort,  both  beautiful  and  blest, 
to  make  a  place  in  a  mother's  arms  as  safe  as  it  looks — to  make  it  the  home  of  life 
as  well  as  of  love,  and  not,  as  it  is  now,  the  haunt  and  harvest  of  death.  It  was 
pathetic  to  discover  that  the  mothers  already  knew  this.  They  knew  no  statistics. 
They  only  knew  babies  and  little  white  coffins.  Try  to  think  what  it  mean.s — if 
you  can  bear  the  poignant  pang  of  this  discovery — to  find  out  through  this  show 
that  mothers  by  the  ten  thousand  knew  that  their  babies  need  not  die,  knew  that 
somewhere  there  were  men  who  knew  what  would  save  their  babies,  and  yet  knew 
no  place  where  they  could  get  this  precious  knowledge,  this  buckler  and  shield 
against  the  darts  of  death,  aimed  at  the  babies  in  their  arms. 

The  instant  the  Philadelphia  Baby   Saving   Show  was  opened  it  filled  with 

mothers.     Every  day  it  filled  over  and  over  again.     They  came  by  companies,  by 

regiments,  by  brigades,  and  by  divisions.     No  Philadelphia  procession  ever  equaled 

the  numbers  in  these  throngs  seeking  knowledge  how  to  keep  their  babies  alive. 

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4  FOREWORD 

It  was  given  them.  It  was  flung  out  in  print.  It  was  made  plain  in  placards. 
Models  made  it  still  plainer.  Safety  was  acted.  Hundreds  of  young  women, 
trained  in  this  wondrous  tale,  told  it  in  booth  and  alcove.  The  future  mother, 
patiently  waiting  until  she  met  her  chance  of  one  death  in  twenty  in  childbirth, 
came  to  hear  lectures  that  she  might  save  the  child  below  her  heart  from  one 
death  in  five  births  that  lay  in  wait  for  it.  Girls  came  with  their  dolls  to  learn  how 
they  could  care  later  for  their  babies.  Women  about  to  be  married  came  and 
learned  the  perils  disease  sows  and  sets  in  the  path  of  careless  love.  Men  learned 
how  they  slay  mother  and  child  in  an  ignorance  deadlier  than  Herod's. 

IF  ONE  BABY  SAVING  SHOW  DID  THIS  IN  ONE  CITY,  AS  IS  HERE  SET 
DOWN,  WHY  NOT  HAVE  A  BABY  SAVING  SHOW  IN  EVERY  CITY,  EVERY 
YEAR  ? 

Talcott  Williams. 


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Table  of  Contents 


PAOB 

Foreword 3 

List  of  lLLr3TR.\TioNS 7 

Introduction 9 

draectory  and  catalogue  of  exhibits,  charts,  diagrams,  signs,  and  illustrations 19 

Bureau  of  the  Census,  U.  S.  Department  of  Commerce  and  Labor 21 

The  Pennsylvania  State  Department  of  Health 25 

Hereditary  S^-pliilis 30 

Heredity  and  Eugenics 34 

Housing  and  Environment 39 

Exhibit  of  the  Housing  Commission,  Philadelphia 53 

The  Visiting  Nurse  Society,  Philadelphia 61 

Conditions  Relating  to  Maternal  Environment  During  Pregnancy 71 

Care  of  the  New  Born 75 

Committee  for  Prevention. — X.  Y.  Association  for  the  I$lind 78 

A  Model  Diet  Kitchen 82 

Department  of  Public  Health  and  Charities,  Bureau  of  Health,  Philadelphia 83 

Division  of  Bacteriology,  Laboratorj'  of  Hygiene 83 

Communicable  Diseases 83 

The  Philadelphia  Hospital  for  Contagious  Diseases 89 

Division  of  Vital  Statistics,  Bureau  of  Health.  Philadelphia 91 

Division  of  Child  Hygiene,  Bureau  of  Health,  Philadelphia 92 

U.  S.  Public  Health  and  Marine  Hospital  Service 94 

Health  Department  of  the  District  of  Columbia 95 

Diseases  Other  than  Communicable 95 

U.  S.  Department  of  Agriculture,  Bureau  of  Chemistry 103 

Philadelphia  Pediatric  Society's  Milk  Commission 105 

The  Pennsylvania  State  Livestock  Sanitary  Board 107 

The  Care  of  Milk  in  the  Home 107 

Infant  Feeding IH 

Utensils  Used  in  Infant  Feeding Ill 

Foods  and  Food  Values 113 

Arti6cial  Feeding 122 

Breast  Feeding 129 

Rules  for  the  Nursing  Mother 133 

Care  of  the  Baby 137 

Bad  Booth 145 

Patent  Medicines  and  Soothing  Syrups 147 

Patent  Foods 149 

Hospitals  and  Institutions 154 

Lectures  and  Speakers  at  the  Baby  Sa\7ng  Show 154 

Lectures  and  Speakers  at  the  Subsidiary  Shows 161 

Down-town  Subsidiary  Show 161 

Kensington  Subsidiary  Show 162 

Germantown  Subsidiary  Show 162 

Manayunk  Subsidiary  Show 163 

5 


6  TABLE  OF  CONTENTS 

PAGE 

Committees  and  Organization 167 

Financial  Statement 173 

Guarantors 174 

Contributors 175 

Proceedings  of  the  Conference  on  Infant  Hygiene 179 

First  Session 179 

Introductory  Address  of  Mr.  Homer  Folks 180 

Municipal  Child  Bureaus,  by  S.  Josephine  Baker,  M.D 182 

Discussion 188 

Infant  Milk  Depots,  by  Rowland  Godfrey  Freeman,  M.D 191 

Discussion 201 

A  Consideration  of  the  Social  Service  Work  of  the  Department  of  Diseases  of  Children 

in  the  Massachusetts  General  Hospital,  by  Dr.  Fritz  B.  Talbot 204 

Discussion 208 

Second  Session 213 

The  Regulation  of  Midwifery,  by  Dr.  James  L.  Huntington 213 

Discussion 219 

The  Control  of  Marriages  of  the  Unfit,  by  Henry  H.  Goddard,  Ph.D 221 

Discussion 223 

The  Effect  of  Housing  Upon  Infant  Mortality,  by  Prof.  C.-E.  A.  Winslow 228 

Discussion 231 

Third  Session 234 

Institutional  Care  of  Infants,  by  Hastings  H.  Hart,  LL.D 235 

The  Henry  Street  Settlement's  Contribution  Toward  the  Conservation  of  Infant  Health 

and  Life,  by  Elizabeth  E.  Farrell 241 

Prenatal  Care  of  Infants,  by  Mrs.  William  Lowell  Putnam 245 

Discussion 249 

Education  for  Better  Parenthood,  by  Dr.  Helen  C.  Putnam 251 

Discussion 257 

The  Value  of  Recreation  in  Relation  to  Infant  Mortality,  by  Mrs.  Luther  H.  Gulick  .  .  258 

Discussion 263 

Index 265 


List  of  Illustrations 


PLATE  PAQB 

I.  SUiirway  Approaching  the  Main  Exhibit  Hall Frontispiece 

II.  The  (\>aches  of  Our  Patrons Facing  4 

III.  The  Kest  Room  for  Mothers  and  Babies "  8 

IV.  Main  Exhibition  Hall  (looking  west) "  12 

V.   Main  Exhibition  Hall  (looking  east) "  16 

VI.  Directory  of  Main  Hall  and  Exhibit  Spaces  in  Wstibule,  Foyer,  and  Corridors 20 

\TI.  Vestibule  South — Charts  from  tlie  Exhibit  of  Tlie  Bureau  of  Census,  U.  S.  Dept.  of 
Comracrec  and  Labor.     Showing  the  Proportion  of  Deaths  of  Infants  under  One  Year 

and  Children  Under  Five  Years  of  Age  to  ToUiI  Deaths  at  all  Ages 22 

VIII.  Vestibule  North — Pennsylvania  State  Department  of  Health 26 

IX.  Section  A.  O.  Hereditary  Syphilis.     The  Sy[)hilis  Germ  and  Characteristic  Lesions.  ...  32 

X.  Section  A,  No.  i.     Portion  of  Exhibit  on  Heredity  an<l  Eugenics .  38 

XI.  Charts  Showing  the  Rosult.s  of  Hou.'ic  Infection   with  Tuberculosis  and  the  Effects  of 

Overcrowding  as  a  Cause  of  Infant  Mortality 40 

XII.  Charts  and  Photographs  Relating  to  Housing  and  Environment 48 

XIII.  Charts  and  Photographs  Relating  to  Housing  and  Environment 50 

XIV.  Section  A,  No.  4.     Housing  and  Environment 62 

XV.  Section  A,  No.  6.     Housing  and  Environment.      Exhibit  of  Housing  Commission  of 

Philadelphia 54 

XVI.  Photographs  and  Charts,  Housing  Commission  of  Philadelphia 66 

XVII.  Photographs  and  Charts,  Housing  Commission  of  Philadelphia 68 

XVIII.  Section  .\,  No.  8.     Visiting  Nurse  Society  of  Philadelphia 60 

XIX.  Photographs  and  Charts,  Visiting  Nurse  Society  of  Philadelphia 62 

XX.  Photographs  and  Charts,  Visiting  Nurse  Society  of  Philadelphia 64 

XXI.  Little  Mothers  Receiving  Instruction 66 

XXII  A.  Section  A,  No.  5.     Bad  Room — Actual  reproduction  of  insanitary  conditions  found  in  a 

room  opening  into  a  blind  alley  in  Philadelphia 68 

XXII  B  (xxiii).  Section  A,  No.  7.     Improved  Room — Showing  how  the  Bad  Room   was  im- 
proved at  small  amount  of  expense 69 

XXIV.  Section  A,  No  12.     E.xhibit  of  Charts  Relating  to  Prenatal  Environment 70 

XXV.  Section  A,  No.  10.     Charts  and  Photographs  Relating  to  the  Care  of  the  New  Bom ....  74 
XXVI.  Section  A,  No.  1 1 .     Charts  and  Photographs,  Committee  for  Prevention,  N.  Y.  Asso- 
ciation for  the  Blind 80 

XXVII.  Section   B,   No.   13.     Division  of    Bacteriologj-,  Laboratory  of    Hygiene.  Bureau   of 

Health,  Philadelphia 84 

XXVIII.  Section  B,  No.  14.     Communicable  Diseases,  Bureau  of  Health,  Department  of  Pub- 
lic Health  and  Charities,  Philadelphia 88 

XXIX.  Section  B,  No.  16.     Division  of  Vital  Statistics,  Bureau  of  Health,  Department  of 

Public  Health  and  Charities,  Philadelphia 90 

XXX.  Section  C,  No.  ^1.     Diseases  Other  Than  Communicable 96 

XXXI.  Section  C,  No.  22.     U.  S.  Department  of  Agriculture,  Bureau  of  Chemistry 100 

XXXII.  V.  S.  Department  of  Agriculture,  Bureau  of  Chemistry,  Chart  Showing  Composition 

of  Foods  for  Infants 101 

7 


8  LIST  OF  ILLUSTRATIONS 

PLATB  PAGE 

XXXIII.  U.  S.  Department  of  Agriculture,  Bureau  of  Chemistry.     Chart  Showing  Milk  Basis  of 
Infant  Foods 102 

XXXIV.  Section  C,  No.  23.     Philadelphia  Pediatric  Society's  Milk  Commission 104 

XXXV.  Section  C,  No.  24.     Production  and  Handling  of  Milk 106 

XXXVI.  Section  D,  No.  26.     Division  of  Infant  Feeding.     Utensils  Used  in  Preparation  of  Foods 

for  Infant  Feeding 110 

XXXVII.  Section  D,  No.  28.     Chief  Foodstuffs  in  Amounts  Needed  at  Different  Ages 114 

XXXVIII.  Section  D,  No.  28.     Nutritive  Value  of  Foods 116 

XXXIX.  Section  D,  No.  28.     Composition  of  Food  Materials 118 

XL.  Section  D,  No.  28.     Forms  in  Which  Milk  May  Be  Given 120 

XLI.  Section  D.  No.  32.     A  Plain  Clean  Kitchen 126 

XLII.  Section  D,  Nos.  34  and  36.     Breast  Feeding 128 

XLIII.  Section   D,  Nos.  34  and  36.     Reproduction  from  a  Colored  Lithograph  made  from 

an  Original  Water-Color  Painting:  "  Mother  and  Nursing  Child  ";  by  Eleanore  .\bbott  132 

XLIV.  Section  D,  No.  27.     Care  of  the  Baby— Clothing 136 

XLV.  Section  D,  No.  29.     Care  of  the  Baby— Bathing,  Weighing,  etc.  .      138 

XLVI.  Section  D,  No.  33.     Care  of  the  Baby 140 

XLVII.  Section  D,  No.  3.5.     Care  of  the  Baby.     Committee  on  Childhood  Health  Exhibit  of 

Boston 142 

XLVIII.  Section  D,  No.  37.     Committee  on  Childhood  Health  Exhibit  of  Boston 144 

XLIX.  Foyer — "  Bad  Booth" — Patent  Medicines  and  "Soothing  SjTups" 146 

L.  Foyer— "Bad  Booth  "—"AH  Things  Bad  for  Babies" 148 

LI.  Foyer — Mechanical  Device  Indicating  the  Frequency  of  Deaths  of  Infants 150 


Introduction  * 

There  is  no  age  period  in  which  the  number  of  deaths  is  greater  than  during  the 
first  year  of  Hfe,  and  none  in  which  the  number  of  preventable  deaths  is  so  great. 
It  is  also  true  that  this  high  mortality  is  chiefly  amongst  those  who  are  most  ignor- 
ant. It  is  very  manifest,  therefore,  that  if  nmch  impression  is  to  be  made  upon  the 
mortality,  as  well  as  the  morbidity,  of  this  first  year  of  life,  some  means  must  be 
adopted  by  which  this  class  of  pcojjle  can  be  taught  to  understand  the  danger  of  their 
environment  and  of  their  present  methods  of  living,  as  well  as  to  appreciate  the  value 
of  the  preventive  mea.sures  which  intelligent  health  officers  are  endeavoring  to  en- 
force. 

How  is  such  education  to  be  administered?  Ignorance  of  and  indifference 
toward  health  measures  are  as  old  as  man.  To  overcome  this  long-standing 
ignorance  and  prejudice  in  the  shortest  possible  time  is  no  sinecure.  Large  and 
widely  different  groups  of  people  must  be  taught,  and  the  lessons  must  be  presented 
in  such  form  as  to  interest  and  appeal  to  the  intelligence  of  them  all.  The  ignorant 
foreigner,  who  may  not  even  understand  the  English  language  or  be  able  to  read  his 
own,  must  be  enlightened.  The  children  of  the  foreign  born,  who  learn  English 
and  adopt  the  American  ideas  more  quickly  than  their  parents,  must  be  used  not 
only  as  interpreters,  but  also  as  teachers.  They  must  be  taught  that  they  may  teach. 
This  is  also  true  of  the  children  of  the  native  born,  for  in  many  of  the  families  of 
the  poor  the  older  children  are  the  acting  mothers,  the  ones  upon  whom  falls  the 
responsibility  of  caring  for  the  babies  of  the  household. 

Education  must  not  be  limited  to  the  mothers  and  sisters  of  the  family,  how- 
ever. The  fathers  must  be  made  to  understand  what  is  needed  for  the  safeguarding 
of  their  babies'  lives.  This  phase  of  educational  work  has  been  entirely  neglected 
or  left  to  be  imparted  at  second  hand  by  wives  and  children.  Without  this  knowl- 
edge, the  co-operation  of  the  head  of  the  household,  which  is  absolutely  essential, 
will  be  lost,  and  much  of  the  effort  expended  in  teaching  the  wives  and  children  will 
go  for  naught. 

Education  must  extend  also  to  the  more  enlightened  element  of  the  community. 
While  it  is  true  that  relatively  few  of  the  infant  deaths  occur  among  this  latter  class, 
it  must  be  remembered  that  even  here  there  is  a  very  unnecessary  waste.  This  must 
be  prevented,  and  at  the  same  time  the  educated  classes  must  be  made  to  realize 
the  enormity  of  the  infant  death-rate  among  the  poor,  the  conditions  which  cause  it, 
and  the  possibility  of  its  control;  yes,  even  more:  they  must  be  made  to  earnestly 
co-operate  in  the  struggle  to  end  this  unnecessary  slaughter  of  the  innocents. 

*  The  substance  of  this  introduction  was  included  in  a  report  of  the  Philadelphia  Baby  Saving 
Show  to  Section  III  of  the  International  Congre-ss  on  Hygiene  and  Demography,  Washington,  D.C. 

9 


10         REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 

The  ignorance  of  many  of  the  educated,  if  one  may  use  a  paradox,  and  their 
attitude  toward  the  problem  of  baby  saving,  are  incomprehensible.  Whilst  making 
personal  appeals  for  funds  to  finance  this  Baby  Saving  Show,  a  gentleman  of  unusual 
culture  seriously  argued  with  a  member  of  the  committee  that  the  present-day  city 
must  be  looked  upon  as  a  place  for  children  to  die  in— as  little  better  than  a  morgue. 
This  is  only  one  of  several  equally  remarkable  view-points  that  were  encountered. 
The  minds  of  such  men  must  be  cleared.  They  must  be  brought  face  to  face  with 
the  living  problems  ;  they  must  see  things  as  they  are,  so  that  they  may  understand 
why  they  should  not  be. 

What  are  we  doing  to  educate  these  widely  divergent  groups  of  people?  How, 
for  instance,  are  we  telling  the  educated  and  comfortably  situated  in  life  how  the 
other  half  lives,  of  the  morbidity  and  mortality  of  their  children,  of  the  causes  that 
produce  these  results,  and  the  possibility  of  their  prevention?  Occasional  items 
appear  in  the  public  press,  occasional  articles  are  published  in  weekly  or  monthly 
magazines,  occasional  lectures  are  delivered,  and  occasionally  health  boards  issue 
health  pamphlets.  Doubtless  these  documents  are  read  by  some,  remembered  for 
a  time,  and  then  forgotten.  It  is  questionable  whether  the  newspaper  and  magazine 
articles  so  much  as  counteract  the  baneful  influences  of  the  beautifully  illustrated 
and  richly  promising  patent  food  and  drug  advertisements  which  many  of  these 
publications  contain.     Only  a  small  minority  can  be  reached  through  these  avenues. 

Federal,  State,  and  municipal  governments  are  studying  the  problem  of  baby 
saving;  charitable  institutions  and  organizations  are  adding  their  efforts;  and  great 
international  congresses  are  being  held  in  the  interest  of  the  babies.  The  educated 
public  knows  that  something  is  going  on,  perhaps  that  the  lives  of  babies  are  under 
consideration,  but  they  do  not  get  from  such  activities  an  intimate  knowledge  of  the 
facts  which  they  must  have  before  we  can  hope  to  secure  their  active  co-operation  in 
working  out  this  great  problem  of  baby  saving. 

For  the  other  class — the  ignorant  poor — much  more  direct  work  is  being 
done.  Printed  instructions  upon  the  care  of  the  baby  and  on  general  matters  of 
hygiene,  easy  of  comprehension,  and  in  the  necessary  languages,  are  being  distri- 
buted. What  is  of  more  imi)ortance,  municipalities  are  establishing  departments 
of  Child  Hygiene  which  have  their  milk  stations  and  various  other  educational 
centers,  and  their  corps  of  social  workers  and  visiting  nurses  who  carry  the  desired 
knowledge  directly  into  the  home.  Social  organizations  are  establishing  educational 
settlements  in  the  densely  populated  and  poverty-stricken  districts  of  our  cities, 
and  conducting  many  other  activities,  the  purpose  of  which  is  to  establish  right 
methods  of  living. 

Relatively  recently,  educational  exhibits  have  come  into  vogue  and  our  limited 
experience  of  them  has  clearly  shown  that  they  must  be  reckoned  among,  if  not 
considered  the  most  efficient,  means  at  our  disposal  for  the  dissemination  of  knowl- 
edge and  the  stimulation  of  public  opinion.  That  most  wonderful  Health  Exhibi- 
tion in  Dresden  last  year,  and  the  very  remarkable  international  tuberculosis 
exhibition  held  in  Washington  a  few  years  ago,  carried  knowledge  of  the  causes, 
ravages,  and  methods  of  prevention  of  the  Great  White  Plague  and  all  other  pre- 


INTRODUCTION  11 

ventable  diseases  to  hundreds  and  thousands  of  individuals  who  would  not  have 
obtained  such  information  in  years  through  the  avenues  previously  described. 

Such  exhibitions  convey  knowledge  through  the  medium  of  both  the  eye  and  the 
ear,  and  as  Professor  Adami  has  well  said,  "It  is  a  principle  absolutely  established 
in  teaching  that  facts  when  reaching  the  brain  through  the  one  channel  of  either 
hearing  or  seeing  a  written  page,  do  not  impress  the  mind  or  become  fixed  therein 
with  the  same  sureness  as  when  both  ear  and  eye  are  employed.  The  graphic 
representation  of  a  condition  is  very  much  more  impressive  than  any  amount  of 
reading  or  study  of  columns  of  figures." 

It  was  because  of  our  belief  in  this  method  of  impressing  the  minds  of  communi- 
ties that  we  organized  a  Bal)y  Saving  Show  in  Philadelphia. 

ORG.\NIZATION  AND  AtSPICES  UNDER  WHICH  THE  SHOW  WAS  HELD 

Recently  there  has  been  organized  in  Philadelphia  a  Committee  having  the 
following  clearly  defined  purpose: 

"The  purpose  of  the  Committee  shall  be  to  make  itupiiry  concerning  condi- 
tions affecting  the  hygiene  of  infants  and  children,  and  make  the  results  of 
such  inquiry  available  to  official  and  pri\at('  agencies  concerned;  and  to 
co-operate  with  the  Department  of  Pul)lic  Ileallli  and  Charities,  the  Board  of 
Education,  and  other  organizations — public  and  private — in  the  promotion 
of  a  comprehensive  and  constructive  program  of  child  hygiene,  based  upon 
adequate  information  and  consideration  of  community  needs." 

This  organization  is  called  The  Child  Hygiene  Committee  of  Philadelphia. 
The  idea  of  a  Baby  Saving  Show  originated  with  Dr.  William  Dufheld  Robin- 
son, a  member  of  this  Committee,  and  was  presented  to  the  Committee  for 
its  consideration  at  one  of  its  earliest  meetings.  The  suggestion  was  ap- 
proved by  the  Committee,  which  determined  to  make  the  conduct  of  The 
Baby  Saving  Show  the  first  activity  of  the  new  organization.  Realizing  the 
importance  of  securing  the  co-operation  of  other  organizations  engaged  in  infant 
welfare  work,  the  Child  Hygiene  Committee  appointed  a  sub-committee  which 
was  authorized  to  select  an  Executive  Committee  for  the  conduct  of  the  Baby 
Saving  Show,  the  personnel  of  which  should  represent  the  various  organizations 
actively  interested  in  the  conservation  of  infant  life.  Such  a  committee  was  formu- 
lated, and  the  Show  was  held  under  the  auspices  of  The  Child  Hygiene  Committee, 
The  Department  of  Public  Health  and  Charities,  and  many  other  co-operating 
agencies. 

Organization. — The  work  of  organizing  the  Show  was  begun  about  three  months 
before  the  date  of  its  opening.  The  plan  of  organization  is  published  in  another 
portion  of  this  report.  As  it  will  show,  about  150  men  and  women  were  actively 
engaged  in  the  work  of  preparation,  and  they  were  compelled  to  work  unremittingly 
during  the  entire  period. 

Publicity. — From  the  time  the  Show  was  decided  upon,  the  press  of  Philadel- 
phia manifested  an  interest.  Occasional  notices  appeared  during  the  first  few 
weeks.     On  the  22d  of  April  a  press  agent  was  appointed  who  supplied  material 


12         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

to  the  newspapers  two  or  three  times  each  week,  which  was  very  fully  published  by 
nearly  all  of  them.  During  the  continuance  of  the  Show  the  papers  published  long 
illustrated  articles  each  day,  some  of  them  continuing  this  practice  during  the  course 
of  the  subsidiary  shows. 

The  press,  next  to  the  comments  of  those  who  visited  the  Show  during  the  first 
days,  was  probably  the  most  potent  factor  in  bringing  the  Show  to  the  attention 
of  the  public.  Other  measures,  such  as  bill  posters,  street  banners,  window  placards, 
and  tickets  to  be  given  in  exchange  for  the  booklet  on  the  care  of  the  baby,  were 
distributed  widely  throughout  the  city. 

Selection  of  the  Time  of  Holding  the  Show. — The  month  of  May  was  chosen  as  the 
most  appropriate  date  for  the  holding  of  the  Show,  as  it  immediately  preceded  the 
period  of  the  year  in  which  the  preventable  infant  deaths  are  most  common. 

Selection  of  Exhibition  Hall. — The  Show  was  formally  opened  on  the  18th  of  May 
in  Horticultural  Hall,  the  largest  and  most  attractive  centrally  located  exhibition 
hall  in  the  city  of  Philadelphia.  The  Committee  felt  that  there  was  much  educa- 
tional value  in  a  setting  that  would  provide  adequate  light,  space,  ventilation,  and 
cleanliness,  and  make  possible  simplicity  and  beauty  of  arrangement  of  exhibits. 

Duration  of  Show. — It  was  determined  to  hold  the  Show  for  a  period  of  nine  days 
in  the  central  portion  of  the  city  and,  later,  for  periods  of  four  days  in  each  of 
four  of  the  thickly  populated  portions  of  the  city.  The  subsidiary  shows  were 
given  for  the  benefit  of  those  who  could  afford  neither  the  time  nor  the  money 
necessary  to  go  to  the  central  portion  of  the  city. 

Subsidiary  Shows. — The  total  attendance  at  the  four  subsidiary  shows  was 
39,831  for  sixteen  days,  as  against  a  total  attendance  of  67,507  for  eight  days  in 
Horticultural  Hall;  21,745  of  the  former  number  came  to  the  first  of  the  four 
shows.  This  show  was  more  satisfactorily  attended  than  the  others,  because  it 
was  held  in  the  crowded  Jewish  section,  and  in  a  hall  which  was  centrally  located 
and  commonly  used  as  an  entertainment  hall  by  the  people  of  the  community. 

There  were  certain  difficulties  connected  with  the  conduct  of  the  subsidiary 
shows  which  naturally  limited  their  popularity.  The  exhibits  could  not  be  moved 
in  their  entirety;  they  had  to  be  quickly  transported  and  quickly  put  into  place; 
the  exhibition  rooms  were  inadequate;  the  arrangement  of  the  exhibits  was  less 
attractive  and  less  effective;  the  conduct  of  the  exhibit  was  more  difficult,  and  ade- 
quate demonstration  was  lacking.  Judging  from  the  size  and  character  of  the 
attendance  upon  the  main  show,  it  is  probable  that  a  larger  group  of  people  could 
have  been  reached  and  more  good  accomplished  had  the  Show  been  continued  for 
another  week  in  the  central  location. 

Cost  of  the  Shoiv. — The  total  amount  of  money  expended  in  the  preparation,  the 
conduct,  the  taking  down  and  transporting  of  the  exhibit  to  the  various  subsidiary 
show  buildings,  its  final  rehabilitation  and  storage,  and  the  publication  of  the  pres- 
ent report,  amounts  to  $14,704.34.  The  Committee  feels  privileged  to  congratu- 
late itself  upon  this  rather  remarkable  showing. 

Method  of  Financing  the  Show. — Practically  this  entire  sum  was  underwritten 
by  a  group  of  public-spirited  private  citizens,  who  guaranteed  amounts  varying 


LXTRODUCTIOX  13 

from  $100  to  $200,  before  any  public  appeal  for  funds  was  made.  An  appropriation 
of  $5,000  by  the  city  government,  together  with  the  general  subscriptions,  enabled 
the  Committee  to  return  to  the  guarantors  about  forty  per  cent,  of  their  guarantees. 

Color  Scheme  for  Charts, Photographs, and  Backgrounds. — Before  the  preparation 
of  the  Exhibit  was  begun,  it  was  decided  to  use  a  uniform  color  scheme  for  the  back- 
grounds and  mountings  of  the  charts  and  photographs,  as  well  as  a  uniform  method 
of  lettering  which  would  be  attractive,  and  at  the  same  time  restful  to  the  eye. 
The  backgrounds  were  of  a  light  sage  green,  and  the  charts  an  ivy  green,  and  the 
lettering,  which  was  in  white,  and  in  the  De  Vinne  type,  of  uniform  size  and  large 
enough  to  be  read  easily  from  a  distance. 

The  Legends. — Realizing  the  discouraging  effect  of  long  legends  and  overful 
descriptions,  we  insisted  upon  short  legends,  clearly,  concisely,  and  directly  expressed, 
and  the  presentation  of  a  small  number  of  salient  points  expressed  in  the  most 
emphatic  way,  rather  than  risk  fatiguing  the  visiting  public  by  setting  fortii  in 
charts  everything  knowni  of  the  various  activities  employed  in  baby  saving.  Intri- 
cate statistical  charts  were  also  eliminated  as  a  feature  of  the  Show.  For  the 
benefit  of  those  who  desired  to  study  them  there  were  exhibited  a  few  admirably 
prepared  statistical  charts  secured  from  the  United  States  Bureau  of  the  Census, 
The  Department  of  Health  of  the  State  of  Pennsylvania,  and  The  Department  of 
Vital  Statistics  of  the  Department  of  Public  Health  and  Charities  of  Philadelphia, 
practically  all  of  which  were  graphically  arranged. 

Object  Teaching. — Realizing,  also,  that  concrete  object  lessons  represent  the 
most  effective  means  of  fixing  facts  in  the  minds  of  people,  much  of  the  exhibit  was 
illustrated  by  means  of  objects,  some  of  the  booths  containing  practically  no  legends. 

Plan  of  Exhibition  Building. — The  Exhibition  Hall  was  divided  as  follows:  On 
the  first  floor  was  the  entrance  hall  to  the  main  stairway,  on  either  side  of  which 
there  was  admirable  space  for  exhibition  purposes,  and  in  the  rear  of  the  building 
there  was  a  large  audience  room,  which  was  used  for  lectures  and  demonstrations. 
On  the  second  floor  there  was  in  the  front  of  the  building  a  large  foyer,  and  leading 
from  this  on  either  side  of  the  stairway  were  wide  corridors,  with  more  than  200 
linear  feet  of  wall  space,  and  back  of  these  the  main  hall  of  the  building. 

Placing  and  Correlation  of  E.rhibiis. — In  the  entrance  hall  to  the  right  of  the 
stairway  was  placed  the  admirable  exhibit  of  the  Department  of  Health  of  the  State 
of  Pennsylvania,  and  to  the  left  the  statistical  exhibit  of  the  Bureau  of  the  Census. 
The  corridors  of  the  second  floor  accommodated  the  loan  exhibits  of  the  various 
charitable  organizations  of  Philadelphia  and  other  cities.  In  the  main  hall  of  the 
second  floor  was  placed  the  main  exhibition,  which  was  created  by  the  Committee 
having  the  Show  in  charge.  It  was  in  this  main  hall  that  the  relationship  of  the 
exhibits  to  each  other  and  the  order  of  their  sequence  were  given  consideration. 
Those  entering  the  hall  were  required  to  follow  a  one-way  arrow.  It  was  the  orig- 
inal plan  of  the  Committee  that  the  exhibits  should  be  arranged  in  the  following 
sequence:  First,  heredity  and  eugenics;  second,  housing  and  environment;  third, 
the  care  of  the  mother  during  pregnancy  and  the  lying-in;  fourth,  the  care  of  the 
new-born;  fifth,  breast  feeding;    sixth,  the  relative  value  of  milk  and  the  proprie- 


14         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

tary  foods;  seventh,  the  production  and  handling  of  milk  and  the  care  of  milk  in 
the  home;  eighth,  the  substitute  feeding  of  infants;  and  ninth,  the  care  of  the  baby, 
its  clothing,  bathing,  exercise,  hours  of  sleep,  etc. 

Owing  to  the  fact  that  it  was  necessary  to  introduce  a  water-supply  into  the 
exhibit  on  artificial  feeding,  it  became  necessary  for  the  Committee  to  change  this 
plan  to  some  extent,  but  in  order  that  the  sequence  might  be  disturbed  as  little  as 
possible,  the  booths  relating  to  the  first  four  subjects  above  referred  to  were  placed 
in  the  southern  division  of  the  hall,  and  those  relating  to  breast  feeding,  the  sub- 
stitute feeding  of  infants,  the  care  of  the  baby,  etc.,  in  the  northern  section.  The 
middle  portion  was  devoted  largely  to  exhibits  relating  to  communicable  and  non- 
communicable  diseases,  together  with  booths  relating  to  the  relative  value  of  milk 
and  the  proprietary  foods,  the  production  and  handling  of  milk  and  the  care  of 
milk  in  the  home,  the  last  three  immediately  preceding  the  substitute  feeding  of 
infants. 

Each  visitor  to  the  Show  had  impressed  upon  him  first  of  all  the  prenatal 
influences  which  afi'ect  the  morbidity  and  mortality  of  infant  life,  influences  concern- 
ing which  the  majority  knew  nothing.  The  lessons  in  this  department  were  so 
directly  taught,  and  the  relationship  of  cause  to  efl'ect  so  clearly  defined,  that  no 
one  of  ordinary  intelligence  could  possibly  fail  to  read  them. 

The  last  booths  visited  before  leaving  the  hall  related  to  the  subject  of  postnatal 
influences,  of  many  of  which  the  visitor  had  heard,  but  concerning  which  he  was 
here  to  learn  more. 

Separation  of  the  Exhibits  of  Proper  and  Improper  Methods. — There  was  one 
feature  in  the  general  arrangement  which  jiroved  of  great  value,  and  that  was  the 
separation  of  the  exhibits  of  incorrect  and  detrimental  methods  and  equipment 
from  those  which  were  correct  and  helpfid.  Experience  in  other  exhibitions  had 
shown  that  where  the  good  and  the  bad  were  placed  side  by  side,  the  illiterate 
classes  had  sometimes  carried  away  and  jiut  into  practice  incorrect  methods, 
assuming  that  anything  which  had  been  observed  in  the  exhibition  was  worthy  of 
imitation.  The  only  studies  in  contrasts  which  were  approved  were  those  between 
good  and  bad  dairy  barns,  illustrated  by  models  representing  the  exhibit  of  the 
Pennsylvania  State  Livestock  Sanitary  Board,  the  right  and  wrong  way  of  caring 
for  milk  in  the  home,  and  a  good  and  bad  living  room.  These  latter  were  reproduc- 
tions of  a  dirty,  dila])idated  room,  which  was  transformed  into  a  clean,  attractive 
room  by  the  expenditure  of  $2.87,  plus  a  little  muscular  effort  on  the  part  of  the 
occupants,  and  a  stirring-up,  by  the  visiting  nurse,  of  the  landlord  and  city  authori- 
ties to  the  point  of  carrying  out  the  sanitary  measures  which  they  were  legally 
bound  to  effect. 

Booth  Containing  Things  Bad  for  Babies. — The  undesirable  things  were  shown 
in  the  foyer,  which  was  in  the  front  of  the  building  and  separated  from  the  main 
hall  by  the  corridors,  and  over  the  entrance  of  which  hung  the  legend,  "Things 
Which  are  Bad  for  the  Baby."  This  arrangement,  aside  from  preventing  confusion, 
enabled  the  Committee  to  broaden  the  scope  of  this  pha.se  of  the  exhibition.  In 
this  booth  were  shown  rooms  with  defective  ventilation,  untidy,  ill-furnished,  and 


INTRODUCTION  15 

overcrowded;  baby  pacifiers;  improper  feeding  bottles  and  nipples;  injurious 
secret  nostrums  and  patent  medicines;  incorrect  methods  of  bathing,  holding,  and 
feeding  babies,  the  bad  effects  of  strong  lights  upon  the  eyes,  etc. 

Section  on  Breast  Feeding. — Especial  effort  was  made  to  lay  stress  upon  the 
importance  of  breast  feeding.  The  booth  devoted  to  this  subject  was  one  of  the 
most  artistically  and  attractively  arranged  in  the  entire  exhibit.  It  contained, 
among  other  things,  some  admirable  photographs  illustrating  the  proper  method 
of  holding  the  baby  during  nursing,  an  advergraph,  an  electrically  operated  instru- 
ment that  displayed  successively  a  series  of  valuable  legends  relating  to  breast 
feeding,  and  an  exquisite  original  water-color  painting  of  a  mother  nursing  her  baby. 
An  admirable  reproduction  of  this  painting,  on  the  reverse  side  of  which  were 
printed  proper  instructions  for  breast  feeding,  was  freely  distributed  from  this 
booth  by  an  attractive,  intelligent  nurse  in  uniform. 

Section  on  Hereditary  Syphilis. — Another  most  successful  section  was  the  one 
relating  to  hereditary  syphilis.  This  was  the  first  exhibit  approached  upon  entering 
the  main  hall.  The  first  charts  defined  in  delicately  framed  but  unmistakable 
language  the  most  common  method  of  conveying  syphilis.  Beside  this  was  a  chart 
defining  the  Was.sermann  reaction  in  simi)le  language,  and,  for  the  purpose  of  attract- 
ing the  eye,  in  the  center  of  this  chart  was  placed  a  series  of  tubes  illustrating  the 
reaction.  Beside  this  were  charts  pointing  out  the  length  of  duration  of  syphilis, 
especially  of  inadequately  treated  syphilis,  the  certainty  of  its  transmission  to  the 
offspring,  and  the  importance  of  the  blood  test  for  those  who  had  had  syphilis, 
especiall.y  those  who  contemplated  matrimony.  The  balance  of  the  exhiljit  con- 
sisted of  colored  drawings  of  the  lesions  of  congenital  syphilis,  each  drawing  bearing 
a  descriptive  legend. 

A  bolilly  illustrated  public  exhibit  of  syphilis  was  entirely  new  to  the  city  of 
Philadeli)hia,  and  its  effect  upon  the  public  mind  was  observed  with  very  great 
interest  by  the  Committee.  It  was  previously  planned  that  this  exhibit  should  be 
very  carefully,  and  at  the  same  time  clearly,  demonstrated,  and  that  no  misinter- 
pretation of  its  purpose  should  be  imparted  to  the  mind  of  any  of  the  j'outhful 
visitors  to  the  exhibit.  There  was  no  part  of  the  Show  that  was  studied  more 
thoughtfully,  and  api^arently  none  that  made  a  deeper  impression. 

As  an  illustration  of  this,  the  following  circumstance  is  of  interest:  A  young 
man  was  observed  to  approach  the  exhibit  and  carefully  study  it  in  every  detail. 
He  was  apparently  much  impressed  and  agitated  by  its  teachings.  He  immediately 
sought  out  a  member  of  the  Committee,  to  whom  he  confessed  that  he  had  had 
syphilis,  that  he  had  been  married  within  a  year,  and  that  his  wife  was  pregnant, 
and  he  desired  to  know  if  there  was  anything  which  he  could  do  to  protect  his 
prospective  offspring  from  the  possibility  of  congenital  syphilis.  It  is  reasonable 
to  assume  that  this  lesson,  which  was  probably  learned  too  late  by  this  young  man, 
was  impressed  upon  the  minds  of  many  of  the  thousands  of  young  people  who  had 
the  opportunity  of  studying  it .  Many  illustrations  of  this  character  could  be  related 
in  regard  to  every  one  of  the  exhibits. 

Demonstrators. — Experience   in   other   exhibitions   held   in   Philadelphia   had 


16         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

impressed  upon  the  Committee  of  the  Baby  Saving  Show  the  importance  of  having 
enough  demonstrators  to  explain  the  exhibits  to  every  one  that  entered  the  exhibi- 
tion building,  consequently  permanent  demonstrators  were  placed  in  practically 
every  booth.  These  demonstrators  were  thoroughly  conversant  with  the  lessons 
the  Committee  desired  to  have  imparted.  In  addition  to  these  special  demonstra- 
tors, there  was  an  adequate  group  of  carefully  selected  demonstrating  guides,  com- 
posed of  young  physicians  and  advanced  medical  students  who  were  conversant 
with  the  general  purposes  of  the  exhibitions,  and  who  piloted  individuals  or  groups 
of  individuals  throughout  the  entire  exhibit.  Besides  these  demonstrators,  there 
were  always  present  in  the  building  a  number  of  members  of  the  Committee  who 
not  only  volunteered  their  services  as  demonstrators,  but  to  whom  any  one  desiring 
special  information  was  referred. 

There  has  probably  been  no  exhibition  in  America  in  which  the  demonstration 
of  the  exhibits  was  more  satisfactorily  conducted,  and  none,  therefore,  we  believe, 
in  which  the  lessons  intended  to  be  taught  were  more  clearly  imparted. 

Aids. — In  addition  to  these  formal  demonstrators,  the  Committee  on  Patron- 
esses and  Aids,  besides  stimulating  wide-spread  interest  through  its  long  list  of  patron- 
esses, provided  a  corps  of  aids.  A  number  of  these  aids  were  constantly  on  duty 
from  the  opening  to  the  closing  hours  of  the  Show.  Two  of  them  were  stationed  at 
the  entrance  to  the  building  to  receive  those  who  attended  the  Show,  to  direct 
them  as  to  the  course  to  follow,  to  pilot  mothers,  who  came  with  babes  in  arms  to 
the  rest  room,  and  to  impart  a  spirit  of  welcome  to  all.  Other  aids  were  located 
at  definite  points  throughout  the  building  to  give  information  and  distribute  the 
literature  that  was  authorized  by  the  Committee. 

Bureau  of  Information. — A  Bureau  of  Information  was  located  just  within  the 
main  entrance  to  the  building.  This  Bureau  was  in  charge  of  a  recent  graduate  of 
The  Woman's  Medical  College.  It  was  her  duty  to  supply  guides  to  direct  any  one 
interested  in  any  special  feature  of  the  exhibition  to  that  part  of  the  building  in 
which  such  feature  was  placed,  to  supply  special  demonstrators  when  so  requested, 
to  receive  requests  for  Hterature  and  pamphlets,  and  to  direct  those  needing  medical 
advice  to  their  physicians,  or,  in  the  event  of  their  being  unable  to  pay  a  physician, 
to  some  one  of  the  various  maternity  and  children's  hospitals. 

Number  and  Personnel  of  the  Visitors. — In  the  nine  days  in  which  the  Show  was 
given  in  Horticultural  Hall  it  was  visited  by  67,507  persons.  Children  of  twelve 
years  and  younger  were  not  admitted  unless  accompanied  by  their  parents  or 
guardians,  and  no  children  or  youths  were  permitted  to  wander  through  the  exhibit 
unattended.  The  personnel  of  the  visitors,  however,  included  a  very  large  group 
of  little  mothers,  whose  attention  was  especially  centered  upon  the  portions  of  the 
exhibit  which  bore  most  directly  upon  the  care  of  the  baby.  Of  the  total  number 
of  visitors,  the  majority  was  unquestionably  made  up  of  prospective  mothers  and 
mothers  with  infants.  One  of  the  demonstrators  in  a  booth  devoted  to  the  clothing 
of  the  baby  was  consulted  by  more  than  a  thousand  pregnant  women,  and  during 
a  single  hour  on  one  day  200  women  with  babies  in  their  arms  entered  the  hall. 
On  this  particular  day  there  were  admitted  1200  mothers  with  babes  in  arms.     The 


IXTRODUCTION  17 

number  of  fathers  who  came  to  get  information  for  mothers  who  could  not  come  was 
striking.  Many  of  them  came  with  pencil  and  pajter  to  make  notes  of  the  things 
they  wished  to  remember. 

An  interesting  feature  was  the  large  attendance  of  the  well-to-do  and  rich,  and 
it  was  very  gratifying  to  see  many  of  these  return  a  second  and  third  time,  selecting 
hours  during  which  the  attendance  was  smallest  in  order  that  they  might  study  the 
exhibits  thoroughly.  The  attraction  of  this  class  of  individuals  was  one  of  the  most 
important  devcloiiments  of  the  Show,  in  that  in  the  sections  bearing  upon  heredity, 
eugenics,  and  housing  conditions,  many  of  them  gained  their  first  knowledge  of  the 
dangers  which  surround  the  offspring  of  the  poor  and  ignorant  inhabitants  of  our 
cities — a  very  important  lesson  for  them  to  have  learned,  since  the  supjiort  of  this 
element  of  the  public  is  very  essential  to  the  carrying  out  of  public  health  measures. 

The  Show  was  very  largely  attended  and  carefully  studied  by  active  social 
workers  and  philanthropists,  not  oidy  from  Philadelphia,  but  also  from  other  cities, 
thus  extending  its  educational  value  beyond  the  confines  of  a  single  city. 

Lectures. — Supplemental  to  the  exhibition  and  with  a  view  to  broadening  the 
scope  of  the  educational  work,  four  short  lectures  were  delivered  in  the  lecture  hall 
on  the  first  floor  of  the  building  each  daj' — two  in  the  afternoon  and  two  in  the  even- 
ing. All  of  these  lectures  related  directly  or  indirectly  to  the  subject  of  baby  .saving, 
and  they  were  delivered  by  men  and  women  from  various  parts  of  the  country  who 
were  especially  conversant  with  the  topics  assigned  them.  Immediately  before  and 
immediately  after  each  series  of  lectures,  and  again  at  midday,  several  educational 
moving  ])ictures*  were  shown.  In  no  way  was  the  desire  of  the  public  to  learn 
better  illustrated  than  in  the  attendance  upon  these  lectures  and  demonstrations. 
The  room,  which  had  a  seating  capacity  of  nearly  300,  was  overtaxed  at  practically 
every  session,  and  the  audiences  were  always  attentive  and  alert. 

The  lectures  and  demonstrations  were  continued  during  the  course  of  the 
subsidiary  shows  and  were  marked  by  the  same  characteristics. 

During  the  week  of  the  main  exhibit,  and  with  a  view  to  attracting  social 
workers  and  all  others  intelligently  interested  in  the  jiroblem  of  baby  saving,  there 
was  held  a  Conference  on  Infant  Hygiene,  the  contributions  to  which  were  almost 
exclusively  made  by  especially  chosen  individuals  from  other  cities.  The  transac- 
tions of  this  Conference,  which  form  a  part  of  this  report,  illustrate  its  scope  and 
value. 

There  are  three  additional  points  to  be  referred  to  in  closing;  they  are — the 
babies'  rest-room,  the  character  of  the  literature  distributed,  and  the  absence  of 
a  commercial  exhibit. 

Realizing  that  many  babies  would  be  brought  to  the  Show,  the  Committee 
considered  it  necessary  to  make  some  provision  for  their  care.  For  this  purpose 
a  room  in  the  rear  of  the  first  floor,  adjacent  to  a  toilet,  was  equipped  with  cribs  and 
all  other  necessary  materials.  The  room  was  presided  over  by  two  trained  nurses 
and  a  resident  physician.  Sanitary  diapers  were  provided,  and  absolute  cleanliness 
was  insisted  upon.     Both  by  example  and  by  word  of  mouth  mothers  were  taught 

*  See  Program. 


18         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

the  value  of  care  and  cleanliness.  Unfortunately,  the  capacity  of  the  room  was 
overtaxed,  but  many  valuable  lessons  were  taught  there,  and,  incidentally,  the 
Committee  learned  the  importance  of  adequately  providing  for  the  care  of  babies 
during  exhibits  of  this  character. 

As  to  the  literature,  but  two  official  documents  were  distributed :  one  the  col- 
ored drawing  already  referred  to,  and  the  other  a  booklet  entitled  "The  Care  of  the 
Baby."  This  latter  was  a  very  carefully  and  attractively  prepared  document 
which  contained  all  the  information  a  mother  would  need  for  the  proper  safeguarding 
of  the  baby,  expressed  in  simple,  direct  language.  The  distribution  of  many  tracts 
and  pamphlets  was  proscribed  because  experience  in  other  exhibitions  had  con- 
vinced the  Committee  that  the  essential  lessons  were  often  lost  in  a  multiplicity 
of  documents. 

No  one  who  has  not  experienced  it  can  appreciate  the  relief  that  comes  from  the 
absence  of  a  commercial  exhibit.  Commercial  exhibits  bring  a  revenue,  but  nothing 
else  of  value,  and  the  revenues  from  rented  space  are  offset  a  thousandfold  by  the 
noise  and  clatter,  the  barking  of  wares,  the  misleading  statements,  and  the  clouding 
of  the  mind  of  those  who  come  to  learn.  Professional  exhibitors  are  versed  in  the 
art  of  demonstrating.  They  know  how  to  touch  the  sympathetic  chord,  and  are 
proficient  in  the  art  of  promising  more  than  they  can  give.  They  lure  the  crowd  and 
center  the  attention  upon  what  they  have,  and  the  real  exhibition,  which  is  of  some 
value,  gets  no  show.  We  recommend  to  all  those  who  contemplate  the  formulation 
of  exhibits  the  elimination  of  the  commercial  exhibitor. 

It  is  a  very  difficult  matter  to  measure  the  effect  of  exhibitions.  It  is  reason- 
able to  assume  that  a  fair  percentage  of  those  who  come  to  learn  will  carry  some 
lessons  away  with  them,  and  that  in  many  instances  they  will  either  directly  or 
indirectly  impart  them  to  others.  In  the  light  of  these  probabilities,  it  would  seem 
that  the  influence  for  good  should  be  far  reaching. 

It  is  too  soon  to  know  the  effect  of  this  Baby  Saving  Show,  but  a  study  of  the 
infant  mortality  of  the  city  for  a  comparison  with  that  of  other  cities  and  an  inquiry 
amongst  physicians,  social  workers,  and  visiting  nurses,  will  probably  justify  the 
hope  of  the  Committee  that  it  has  accomplished  much  for  the  saving  of  babies  in  the 
city  of  Philadelphia. 

In  an  exliibilion,  such  as  is  herein  described,  the  amount  of  labor  involved  in  its  preparation,  and 
the  results  accomplished  by  it,  depend  to  a  very  great  degree  upon  the  character  of  co-operation  extended 
to  its  organizers.  The  Executive  Committee  of  the  Philadelphia  Baby  Saving  Show  were  especially 
fortunate  in  this  respect.  No  aid  was  asked  that  was  not  willingly  and  enthusiastically  given,  not 
alone  by  the  state  and  city,  and  the  many  local  organizations  interested  in  the  problem  of  baby  saving, 
but  also  by  the  Federal  Departments  and  other  institutions  outside  of  Pennsylvania.  The  Committee 
is  especially  obligated  to  The  Bureau  of  Chemistry  of  the  United  States  Department  of  Agriculture,  The 
Bureau  of  the  Census  of  the  United  States  Department  of  Commerce  and  Labor,  The  United  States 
Public  Health  and  Marine  Hospital  Service,  The  Russell  Sage  Foundation,  The  Committee  on  Childhood 
Health  Exhibit  of  Boston,  and  the  Health  Department  of  the  District  of  Columbia. 


Directory  and  Catalogue  of  Exhibits,  Charts, 
Diagrams,  Signs,  and  Ilhistrations 


This  calalnmie  contains  a  copy  of  every  cliart  and  (lie  descriptive  lejicnd  wliich 
ai)peared  on  each  of  tlie  |)hoto,<;ra|)hs  and  drawings  shown  in  the  etitire  exliiliition. 

Many  of  the  iiootiis  and  indivichnd  cliarts  are  ilhistrated. 

The  purpose  of  the  Coniniiltee  in  puliHshinj;  tlie  catalogue  in  tliis  form  is  to 
illustrate  the  scope  of  the  Show,  and  to  make  available  to  those  wishing  to  formulate 
similar  exhiliitions  the  vast  aniouid  of  material  used  in  the  Piiiladelphia  Bahy 
Saving  Show. 

Reatlers  are  advised  to  study  the  Directory  [I'late  \  I]  carefully  in  order  to 
understand  the  divisions  of  the  exhiltit  which  are  referred  to  throughout  the  text. 


Directory 

First  Floor. 


voniK/ie  Department  (fCmroem.mi  Lalwr 
SOUTH  Bureau  of  Census. 


vEsnwLe  Pcnnsyifvaiiia  State  Department 
•">"«  of  Health. 


naxoFTOMtp} --InformatiMi  Bureau.    Ledure  Hall. 
wstiwif-soimij  Rest  Room  fiir  Mothers  »nd  Mxes.   ToUet  Kooms. 


Corridor 

Section  E. 

Chfldreiis  Aid  Society 
Philadelphia. 

Philaifelphia  AssKiatieD 
of  Day  NurseriM. 


The  Babies  Hospital 
of  Fhiladelphia.  J 

Philadtlphia  Modi' '' 
mk  SxkW.        .:. 

mam 

TtThoirasWilsoSmilari™      »' 
BjHimoK.Md.  E" 

St.  (fcrfatrfs  llms()i,l..%ib      3(i„' 
Allany.  N.Y. 

Childim  Hospital 

d  Philadelphia.       acmes 

JtffamHaleniJyUispital    HtMum 


MOOa  OCT  KITCHW 


Fcyer 

Section  F. 
BadBooth 

All  things  bad 
for  the  Babj*: 

Galfeiy^ftjcr 

EjffiodwB  Offices. 
Ladies  Aid  Cnnm 


Pl.\te  VI 
DIRECTORY  OF  M.\IN  HALL  AND  EXHIBIT  SPACES  IN  VESTIBULE,  FOYER    AND  CORRIDORS 


20 


Bureau  of  the  Census 

Dkpartmext  of  Commerce  and  Lahoh 

lA'cstihiilr  Sciiitli.  '2  H(ic>tli-.| 
This  section  coiitaiMrd  --tatiNtiral  iliaj:raiiis  rcialiii^  ti>  ilratlis  ol'  infants. 

TIio  followinii  cx|)lanatorv  descriptions  ()i(I  not  appear  on  the  diatrranis,  hut 
Wfvr  furnislie<l  hy  the  IJurean  al   llie  re(iU(-st  of  lli<'  Coinniit  tee. 

])l-\(ai.\M  NO.  1.  —  Map  Sliiiwini;  I'rescnl  and  I'rospeef  ive  Registration  States 
for  DeatIis.--Re!.;istration  cities  in  non-reuist  ration  States.  Map  sliowiiii;  provi- 
sional hirtli  rei;istration  area.  Not  a  sinjile  State,  not  own  a  siiiijle  city,  in  the 
entire  United  States  ])ossossos  complete  registration  of  l)irtii>.  Md^lon  ( lainis  to 
have  about  theliest — only  !)(i  jjcr  cent.  Tlic  most  utterly  worthU'ss  registration  of 
births  among  all  the  great  cities  of  tlie  enlirc  civilized  world  may  be  claimed  by 
the  cities  of  Baltimore.  Chicago,  and  .New  Orleans, 

Dl.vciHAM  NO.  .'5. —  Decrease  of  Infantile  ^b)rtality. — Infantile  mortality  is 
the  ratio  of  deaths  of  infants  nn<ler  I  year  of  age  ])er  1,000  living  births;  foreign 
countries  by  five-year  ])eriods  ( 1S<S()-1S!)(),  l!)01~190o).  No  rates  of  infantile  mor- 
tality are  available  in  the  liiited  States  because  (1)  there  is  no  general  registration  of 
deaths;  (i)  even  for  areas  with  registration  of  (leaths  the  registration  of  births  is 
incomplete. 

DiAURA.M  No.  4.-  Decrease  of  Infantile  Mortality  in  Cities. — Infantile  mortal- 
ity is  the  ratio  of  deaths  of  infants  under  1  year  of  age  per  1,000  living  births. 
Foreign  cities  by  .same  five-year  i)eriods  as  for  foreign  countries.  Rates  of  infantile 
mortality  can  not  be  given  for  American  cities  on  account  of  their  defective  regis- 
tration of  births. 

Diagram  No.  5. — The  Course  of  Infantile  Mortality. — A  century  of  the  history 
of  infantile  mortality,  showing  all  the  data  availalile  for  various  countries  as  com- 
piled by  the  French  government.  The  foreign  countries  are  the  same  as  in  Diagrams 
Nos.  3  and  -1,  the  century  being  by  five-year  periods  from  ISOl  to  1!)10  for  deaths 
of  infants  under  1  year  of  age  (stillbirths  excluded)  i)er  1,000  living  births.  [From 
Statistique  Generale  de  la  France.] 

The  era  of  modern  sanitary  civilization  may  be  marked  by  the  dates  upon 
which  various  countries  began  to  record  infant  mortality.  Some  countries — China, 
Turkey,  and  the  United  States — even  yet  possess  no  records  of  infant  mortality. 

DiACiRAM  No.  (3. — Watch  the  Birth  Rate  Decrease!  There  are  Fewer  Deaths 
of  Children  Because  Fewer  Children  are  Born. — This  leads,  temporarily,  to  a  lower 
general  death  rate;  later,  to  a  higher  rate  because  of  fewer  young  persons  at  the 
most  healthy  ages.     Moral:    If  fewer  babies  are  born  their  lives  should  be  more 


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22 


DIRECTORY  AM)  CATJ f.ncri'  of  EXHIBITS  23 

carefully  <;iiMr(l('<l.  \ninl)iT  nf  liiiili--  \n-v  1,0(10  liviiiu  |i(>|>nlat  ion  i>l  illhirllis 
excliidod),  and  ])er  cent  decrease  tor  t'nreii;ii  lonntries  l>y  five-year  periods.  No 
hirtli  rates  are  piven  in  tlie  tal>ies  of  International  Statistics  for  the  Inited  States. 
Why'-'  Are  not  the  1)irth--  of  ,\nierican  l)al)ies  worthy  of  reirislration?  .\re  the 
births  of  your  cliildren  ])r()|)crly  rcfiistcrcd?     Why  not'' 

l)l ACRAM  No.  7. — Decrease  of  the  Mirth  I{ate  in  Cities.-  Much  of  I  lie  re(hictioii 
in  t  he  nniniicr  of  Deaths  of  Infants  in  cities,  as  for  conn  tries  as  a  \\  hole,  is  dne  to  the 
tliminished  birth  rate.  Hence  the  necessity  for  i;reater  savint;  of  (he  little  infant 
life  we  are  coniin<j  to  have.  " \u  infant  sa\ed  is  worth  two  infants  born?"  I'er- 
haps.  \ot  even  one  .Vnieric,-in  city  uilli  .-i  birlii  r.itc  worthy  of  inclusion  in  tiie 
International  Statistics?  Not  one  sinf,'le  ouel  and  the  accurate  registration  of 
births  is  the  absohit<'ly  necessary  basis  of  correct  data  of  infant  niorlalily. 

Di\(;n\\i  Xo.S.  Decrease  of  (Iciicral  Death  l{ate. — The  "cruch'""  or  "i:<'neral" 
death  rate  has  decreased  in  most  countries  havintr  accurate  ret;islralion  during; 
recent  years,  '{"his  decrease  is  associat<'il  with  tlu-  reduction  in  infantile  mortality. 
Foreign  conntri<'s  as  in  |ireccdint:  diatrrams.  TJie  ■'cmde'"  or  oi'dinary  death  rale 
(the  term  does  not  mean  the  imjierfcct  or  carelessly  com]>nted  death  rate,  but  is 
used  in  contradistinction  to  a  d<\itli  rate  "corrected"  for  afie,  sex.  or  other  distri- 
bnl  ion  of  populat  ion  i  is  I  lie  first  ready  means  of  comjiarison  for  conditions  alfectiiif; 
mortality.  Human  life,  on  the  whole,  is  becomini;  safer  all  o\-er  the  ci\ili/,ed  world; 
and  for  infants  as  well  as  for  all  aj;es. 

DiACHWi  No.  0. — Decrease  of  (ieneral  Death  Rate  in  Cities.-  The  citie.s 
of  the  world  share  in  the  general  reduction  of  the  death  rate,  and  some,  in  recent 
years,  have  shown  heretofore  unexampled  low  rates.  We  have  reached  an  era  of 
low  mortality;  arc  the  babies  get  t  ing  I  heir  share?  Foreign  count  rics  as  in  preceding 
diagrams  and  number  of  deaths  per  1,000  li\ing  population  ^  stillbirths  excluded) 
by  five-year  i)erio(ls,  with  per  cent  decrease. 

DiAiiiiwi  Xo.  10. — Proportion  of  l")<atlis  of  Infants  One  Year  and  Children 
Under  Five  Years  of  .\ge  to  Total  Deaths  at  All  Ages.  Registration  States:  1!)()!). 
— The  jier  cent  under  1  year  and  under  ,)  years  is  shown  for  the  Registration  .\rea 
and  Registration  Slates,  with  the  i)roportioTi  of  deaths  out  of  every  100  deaths  at 
all  ages,  as  taken  from  bulletin  of  Mortality  Statistics.  190!).  This  is  a  very  un- 
sati.sfactory  comparison,  but  no  reliable  data  of  infantile  mortality  are  available 
becau.se  of  the  lack  of  accurate  registration  of  births. 

Di.\(ii{.\M  No.  11. — ProjMirtion  of  Deaths  of  Infants  Under  One  Year  and 
Children  Under  Five  Years  of  .\ge  to  Total  Deaths  at  All  Ages,  Registration  Cities: 
IDOi). — The  same  data  are  shown  for  Registration  ( 'ities,  1909,  as  in  Diagram  No.  10 
for  States.     (See  Plate  No.  YII.  I 

Di.vGR.\M  No.  l'-2. — Probability  of  Dying  in  Kacli  ^'earof  .Vge  per  1,000  Enter- 
ing Upon  that  Age.  Rate  of  mortality  (qx )  by  age  in  completed  years  from  birth 
to  100  years,  for  Germany  (1891-1900),  England  and  Wales  (1891-1900),  France 
(1898-190;')),  Ma.ssachusetts  (189;5-189T),  Registration  States,  Native  White  (males 
only,  1900),  Italy  (1 899-1  ilO'i),  and  Sweden  (1891-1900),  for  males  and  females 
separately.     Infant  mortality.     Note  how  the  death  curve  resembles  an  ordinary 


24         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

fishhook  (\/)-  The  chief  point  of  this  diagram,  for  the  purposes  of  tliis  meeting, 
is  the  barb.  Prevention  of  diarrheal  diseases  alone  would  cut  down  the  rate  of 
infantile  mortality  by  one-fourth.  It  is  the  object  of  those  interested  in  the 
study  and  jjrevention  of  infant  mortality  to  cut  off  the  bar!)  of  this  hook  of  death. 
High  infant  mortality  means  weakened  childhood,  impaired  youth  and  middle 
life,  and  ])rematurely  feeble  old  age.  The  })oint  of  the  barb  permits  the  entrance  of 
poison  for  tlie  whole  of  life.  The  chances  of  living  ought  to  be  greater  at  birth, 
not  less,  as  at  present,  than  at  other  periods  of  life  until  extreme  old  age. 

Dl\gr.\m  No.  21. — The  Twenty  Most  Imiiortant  Causes  of  Death  at  Each 
Year  of  Age  Under  5,  and  for  the  Five- Year  Period  5  to  9,  Registration  Area  of  the 
United  States:  1909. — Single  years  of  age  from  1  to  4,  five-year  period  5  to  9,  with 
per  cent  of  all  known  causes  at  each  age,  are  shown.  The  surfaces  of  the  Circles 
are  Proportional  to  the  Total  Number  of  Deaths  at  Each  Age. 

DiAGR.\M  No.  22. — The  Twenty  Most  Important  Causes  of  Death  at  Each 
Decade  of  Human  Life  According  to  the  Returns  for  the  Registration  Area  of  the 
United  States:  1909. — Per  cent  of  all  known  causes  at  each  age  period.  Ten-year 
age  periods  are  shown  from  under  10  years  to  90  years  and  over.  The  Surfaces  of 
the  Circles  are  Proportional  to  the  Total  Number  of  Deaths  from  Known  Causes  at 
Each  Age  Period. 

Di.^GRAM  No.  25. — Most  Important  Causes  of  Infant  Mortality.— Actual 
deaths  in  the  registration  area  of  the  United  States,  1909,  from  all  cau.ses  of  death 
responsible  for  as  much  as  1  death  in  100  at  either  the  First  (0-)  or  Second  (1-) 
years  of  life.  Causes  of  death  by  age  and  number  of  deaths  from  10,000  to  30,000 
are  shown.  The  names  of  all  preventalile  causes  of  infant  mortality  (wholly  or  in 
large  j)art)  are  in  red.  Detailed  data  and  percentages  in  Census  Bulletin  on  Mortal- 
ity Statistics,  1909. 

Di.\GR.\M  No.  26. — The  Greatest  Foe  of  Infant  Life  is  Diarrhea  and  Enteritis. 
— Over  two-thirds  of  the  deaths  from  this  disease  are  those  of  babies  under  1  year. 
The  number  of  deaths  during  five  years  by  calendar  months  for  the  registration  area 
of  the  United  States,  1900-1904,  is  shown.  Diarrhea  and  enteritis  (which  term 
includes  cholera  infantum,  gastroenteritis,  milk  infection,  intestinal  toxemia,  etc.) 
is  a  seasonal  disease.  That  is  to  say,  hot  weather  ]3ermits  rajjid  ])utrefactive 
changes  in  uncooled  and  filth-infected  food,  more  especially  the  baby's  milk. 
Breast-fed  children  largely  escape.     (See  Plate  \TI.) 

Diagram  No.  27. — The  Keystone  of  the  Arch  of  Public  Health  is  the  Saving 
of  Infant  Lives.  The  Keystone  in  the  Saving  of  Infant  Lives  is  the  Complete 
Resistration  of  Births.  The  Keystone  in  tlie  Development  of  Effective  and 
Thorough  liirtli  Registration  in  the  United  States  is  the  Commonwealth  of 
Pennsylvania. 

The  Committee  on  Birth  Registration  of  the  American  Association  for  the 
Study  and  Prevention  of  Infant  Mortality  reported,  in  1910,  that  "The  only  state 
in  the  Union  in  which,  now  or  at  any  former  time,  a  determined  effort  has  been  made 
to  tlioroughly  enforce  the  registration  of  births,  as  the  law  provides  and  with 


DTRKCTOny  AXn  CATAL0(,VK  of  KXHlBfTS  2.> 

prosecution  and  enforcement  of  the  |)en;ilty  of  the  hiw  in  (ielinquent  cases,  is  the 
Commonwealth  of  Pennsylvania." 

The  effective  work  of  the  Bureau  of  \\\:\\  Statistics  of  the  State  Department 
of  Health  of  Pennsylvania  is  the  keystone  of  our  h<)p(-  for  conii)lete  national  regis- 
tration of  vital  statistics  and  national  life-savin<;  of  infants  based  on  sound  statistics 
of  infant  mortality. 


The  Pcnnsi/lvania  State  Departmefit  of  Health 

Vestiljulf,  X.jrtli  Siile,  3  lioiitlis.      (I'lalc  \  III  is  a  R-pn.cluctiuii  i.f  tlic  ('ciilr.il  Ho.itli.) 

Charts. 


The  minuti'  analysis  of  ilcatlis  of  iiilauts  Ky  days,  weeks,  and  iiKinlhs  for 
the  i)rincipal  lauscs  of  <lealh,  lorcilily  iiiustralcs  tiie  (hnition  which 
prenatal  as  well  as  |)ostnata!  pre\-eiitivc  measures  nuist  lake  in  order  to  he 
most  effective. 


1.  Cluirl  sliuwiuf;  llie  currclatinn  of  \  ital  faits  in  llii'  sliidy  cif  infant  iiiciitality. 


The  ('iirrdiiliiiii  of  Vila]  Vartx  is  ahsolutcly 

necessary  to  a  Ihorouph  under- 

standiui;  of  ail  human  ])r()l)lems.     P^very 

iteiu  of  information  on  certifi- 

cates  of  hirtlis.  deaths,  marriai^'cs,  reports 

of  comnnuiicable   diseases   has 

its  special  simiificance.      Note  how  frecpu 

•ntly  the  aue  and  cause  ot  death 

ai)i)ear  as    failors  in  mortality  tallies  and 

the  aiic  ot  the  mollicr  in  birth 

tables. 

2.  Table  .sliowing  the  analysis  of  deatlis  of  infants  from  principal  c-aii.scs  hy  Hays 
for  tlie  first  week.  Ijv  weeks  for  the  first  month,  an<l  liy  months  for  the  first  two 
years  of  life. 

3.  Graphic  chart  showing  the  relative  freqnency  of  deaths  in  the  first  year  of 
life  and  in  i;nnii)s  of  popnlation  at  each  succeeding  five-year  age  period.  (See 
Plate  VIII.l 

4.  Graphic-  chart  shr>wing  the  mortality  curve  from  infancy  to  old  age. 

5.  Chart  showing  ilivision  of  infant  mortality  into  five  principal  groups. 

The  average  niunber  of  rhildrcn  lincludin"-  ju-evious  births)  born  to  al 
mothers  was  ;?.o;   to  native  mother.s,  3.3;   and  to  foreign  mothers,  3.8. 

6.  Chart  showing  the  nundicr  of  <'hildren  per  mother  according  to  nativity. 


z 


2 

< 


Z 

z 


H 
O 

z 


w 
> 


36 


DIRECTORY  AM)  (  ATALOGUE  OF  EXHIBITS 

The  averaf;o  nunihcr  of  lixiiiu  cliiMrcn  to  cacli  inotticr  Miii-ludiiii:  iircsciit 
l)irth.s)  was  'i.'.);  to  iiati\c  iiiotlicrs,  '2.S,  and  to  lorciiTii  inotlicrs.  .'i.l. 


Tho  average  age  of  all  iiiotlicrs  is  -iS.;!  years;  of  native  mothers.  '2S  years, 
and  of  foreign  mothers,  '•2!S.)S  years. 

7.  ( "iiart  sliowing  age  of  mother  acctiniiiig  tt)  iiati\  ily. 

Rnral  infant  mortality  rates  are  largely  influenced  l>y  tlu>  large  foreign 
j)oi)ulation  in  industrial  settlements  outside  of  cities.  The  uriian  hirtii- 
rate  is  ^.S.'-i  and  th<'  rin-al  rate.  ;!0.7. 

S.   Cliart  siu)\\in<;  jirctjiortiiui  iM-lwern  rural  and  nrliaii  inortality. 

\'ital  statistics  are  eolleete<l  in  I'ennsvK  ,-iMia  through  the  medium  of 
1.1(17  local  registrars.  Kadi  spot  on  the  map  indicates  the  locat  ion  of  t  liese 
officials. 

iMap  i>f  I'ciiiis\  hania  iruiicaling  location  of  registrars.) 

Infant  mortality  should  include  the  |)n'natal  morlalily  occurring  lielwecn 
the  fourth  mouth  of  |)regnancv  and  liirtli.  which  amounts  to  !>,.>.S7  deaths 
per  year.  These  are  recorded  as  .stillhirths  and  do  not  appear  in  mortality 
tables. 


The  prom])t  and  com])lete  registration  of  e\-cry  hirth  is  a  legal  and  sanitary 
neeessit\'.  advantageous  alike  to  the  child  and  to  the  state. 


A  nation  without  ahundant  and  healthy  children  is  hut  a  few  generations 
removed  from  degeneracy. 

\'ital  statistics  flash  the  wireless  messages  of  death  from  lips  that  have 
never  learned  to  sjjeak. 

The  female  mackerel  lays  ,50,(100  eggs.  .Esop  tells  of  the  fox  taunting  the 
lion  with  the  .smallness  of  his  family,  to  which  he  replied:  "Yes — hut  then 
every  child  is  a  lion."  Are  our  children  to  he  in  the  mackerel  or  the  lion 
class? 

The  S.  ().  S.  call  of  helpless  infancy  should  not  lie  unanswered  by  twentieth 
century  civilization. 

Two  luuulred  men  in  Pcnn.sylvania  toil  each  day  in  digging  graves  for 
people  who  die  untimely  deaths  from  preventable  causes.  One-half  of 
these  graves  are  for  babies. 


28    REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 


Infancy  and  old  age  are  comrades  in  deatli.     The  man  of  84  stands  a 
somewhat  better  chance  of  living  one  week  than  does  the  baby  at  birtli. 


A  Government's  interest  in  human  life  should  begin  before  conception 
and  end  onlj'  in  the  grave. 

The  yearly  failure  of  one  business  enterprise  in  every  ten  would  mean  a 
perpetual  financial  i>anic.  The  yearly  loss  of  one  baby  in  every  seven 
creates  simply  a  mild  alarm. 

The  rejiroduction  of  all  species  is  a  normal  natural  process.  In  the 
human  family  it  is  more  or  less  a  matter  of  accident. 

A  baby  has  the  right  to  be  well  liorn.     Its  clioice  of  parents  is  not  its  own. 

If  babies'  bottles  were  blown  in  the  shape  of  cothns  they  might  hint  at 
possible  tragedies. 

The  wordless  sobs  of  suffering  babyhooil  sliould  outshine  the  eloquence  of 
all  ages  and  all  languages. 

Infant  mortality  is  the  "yard-stick"  which  measures  the  height  of  social 
welfare  and  the  breadth  of  human  efficiency. 

Prematurity  or  immaturity  very  often  means  overworking,  overheating, 
and  underfeeding  and  too  often  a  want  of  understanding. 


Each  and  every  child  should  be  a  ward  of  the  state  and  nation.  It  sjiould 
not  have  to  be  an  orphan  to  become  such.  A.sylunis  and  foundlings' 
homes  make  comparatively  poor  step-mothers. 


Contagious  diseases  play  a  comparatively  small  i)art  in  infant  mortality. 


The  baby  as  a  business  proposition: 

You  can  insure  the  life  of  a  healthy  baby  only  after  it  has  lived  one  month 
and  only  for  a  maximum  of  twenty-five  dollars.    You  can  insure  the  unborn 
progeny  of  animals  for  thousands  of  dollars.     Is  this  a  reflection  on  the 
human  babv,  its  mother,  or  on  our  own  intelligence? 


DIRECTORY  AM)  CATALOCVK  OF  EXHIBITS  29 

I'hci|uf,'rai)lis. 
Tnherciiloiis    fliildron    (in    tlicir    way    to    tlic    State    Sotitli    ^lomitaiii. 

Saiiatdrimn  at  Mont  Alto,  wlirrc  cliilclrcn  nf  all  a^'os  arc  fared  for. 

Incipient  anil  A(i\ancc(i    Inlicrciilosis. 

Penna.  State  Sonth  Mountain  Saiiatoriiini.  Mont  Alto. 

IJahy's  hatli-aii  event  in  tlic  family  1 

Practical    ])reveiitlve    work    anions:    the    lialiio    hy    State    'i'Mlierctiiosi.s 
Dispensary  Nisiting  Nur.ses. 

Ilealtli. 

Mont  .Vllo  Sanatorium. 

Hos|)ital  for  Infants  and  (  liildrcn.      Capacity.  Kill  lieds. 

.V  fightint;  chance  for  a   luKcrcnlous  mother  and  two  haliie-;  M(Mnporary 
open-air  slee])in^'-room  on  a  roof  costini;  .l^'iT. .)()!. 

I'lie  closed  window  opens  tlii'  door  to  the  undertaker. 

Two-fool  hed-rooni  window,  naile<i  shut  — eit;ht  sleejiers — three  tui>ercu- 
lous  ciiildren.  aijes  one,  two,  and  five. 

(Ai'lual  c.iiiiiiliim.) 

Fresh  .Vir — Health:   .\  hcd-rooni  .it  the  Statt' Sanatorium,  Mont  .\lto. 

Instruction  liy  the  vi>itiiiji  nurse  in  the  jirojier  ))re|)aralion  of  food,  a  most 
important  feature  in  ])reventiiig  infant  mortality. 

\  danyeroiis  custom.      How  diseases  often  siipjiosed  to  he  hereditary  are 
transmitted. 

Every  city   in   Pennsylvania   has  some  sections  like  this.     Bad  housing, 
foul  air,  liiuh  infant  mortality. 

Polluted   streams  are  res]lon^illle   for  more  typhoiil  fever  than  all  other 
sources  coinhiiuHl. 

The  free  distribution  of  antitoxins  to  the  indigent  forms  an  ini[iortant 
feature  in  the  prevention  of  infant  mortality. 
(Samples  of  antitoxin. ) 


30         REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 

Her  editor  1/  Syphilis 

Hereditary  syphilis  is  a  child  destroyer 

This  l)ooth  contained  9  charts  which  are  self-cx|  lanatory. 

Section  A.  O. 

Chart  1.— Iniiicating  the  way  in  which  syphihs  is  transmitted. 
Children  inherit  syphilis  usually  from  the  father.     Syphilis  in  the  adult  is 
curable.     An  adiiit  ha\ing  syphilis  should  never  marry  until  cured. 

A  man  having  uncured  .syi)hilis  will  give  the  disease  to  his  wife.  Syphilis 
in  either  parent  is  a  very  common  cause  of  abortions,  miscarriages  and 
stilll)irths. 

Beware  of  tlie  advertisements  or  advice  of  those  wlio  promise  quick  cures. 
Syphilis  shoidd  be  treated  for  at  least  five  years. 

The  one  big  cause  of  the  spread  of  syphilis  is  immorality  between  men  and 
women.  Therefore  the  stn-e  means  to  stamp  out  sy|)hilis  is  for  men  and 
women  to  be  moral  in  the  sex  relations.  Protect  your  future  children 
against  syphilis  by  yourself  leading  a  virtuous  life. 

If  you  have  ever  had  syi)hilis,  be  examined  by  a  ])hysician  and  have  your 
blood  tested  before  being  married  and  becoming  a  parent. 

Chart  2.— The  blood-test  for  syphilis. 
Tubes  1.  2,  and  3  contain  the  blood  from  three  different  persons.     Tubes 
la,  2a,  and  3a  contain  blood  from  the  same  three  patients  to  which  have 
been  added  the  reagents  for  the  blood-test  for  syphilis. 

Tube  1  is  from  a  man  who  does  not  have  syphilis  as  jjroved  by  absence  of 
any  change  in  tiie  la  tube. 

Tulie  ^  is  from  a  man  wlio  contracted  syphilis  1  fi  years  ago.  He  has  shown 
no  signs  of  the  disease  for  13  years.  He  thought  lie  was  cured  and  married 
six  years  ago.  He  has  a  son  five  years  old  who  developed  hereditary 
syphilis  of  the  eye  and  skin.  The  father  then  had  his  own  blood  tested, 
and  the  tube  'ia  shows  he  still  has  the  disease  himself.  He  had  not  had 
enough  treatment  to  ciu-c  his  syphilis  Ijcfore  being  married. 

A  })lood-test  in  a  case  like  this  woidd  have  shown  the  need  for  more  treat- 
ment before  marriage  and  saved  the  child  from  hereditary  syphilis.  In 
tube  3  is  the  blood  from  the  five-year-old  son  of  the  tube  i  man.  The 
change  in  tube  3a  proves  the  child  lias  syphilis. 

Chart  3. — Syphilis  both  in  adults  and  in  chiUlren  is  a  common  disease  in  all  parts 

of  the  world. 

Syphilis  may  be  contracted  innocently.  One  of  the  commonest  innocent 
causes  of  syphilis  is  kissing  an  adult  or  baby  having  the  disease.  A  baby 
may  contract  the  disease  from  a  wet-nurse  wlio  has  syphilis. 


DIRECTOR)'    I.V/)  (ATA WOVE  OE  EXHIBITS  31 

(hart  4  — I'Sci"  Plate  IX.)      Tlir  syi)liilis  i;,Tm. 

PhotoKrapli^  of  liviiit;  syphilis      Ji,  A.  I?.  (',  I>.  iS.  E.  the  gt'rii!  is  niimnificd  lOnn  times, 
P"|"  ;iuil  in  !•"  ^S;  (..  k")()(l  times. 

Diagram.    Sypliilis  germs  frum       'y\^\s    (•()rk-s<Te\v-slia|ie(l    i;cnn     is    tli<-    cause    of    sypli- 
""•■''^'"-  ills.      It    invades   every  tisMie  of   tlie   iiody.      It    is   nsn- 

aily   conveyed    to   tiie   patient    liy   direct    contact    willi 
Diagram.     Syphilis   germs   in       .^    sypl,i|itic   .sore.      It    is    most    often    con\c\-ed    dnring 
lif'sv'.hiiis'"'"'"'"™  ''"''' ''""'      ill.'t:itiniate    sex    relations.      It     is     fre.,nently_  due    to 
'''^'"'"''  monlli-to-nioutli  kissinj;-.     The  ycrni    is  sometimes  car- 

ried  to  an   innocent   jjcrson  on  towels,  razors,  drinkiiii; 
Diagram.      Syplnlis   germs    m  ^^.,^j^.,^   ,^,^^.^,  j^^.^.^^   ^^^^.^i   ,,^.   ^,,„,^.  ,,„^,   haxuvj, 

spleen  of  lieaii  bahy,  ,   '     ,. 

the  disease. 

S\i)liilis    in    a    contat:ioiis    form    alwavs    remains    Inrk- 
Diagram.      Syplnhs    germs    ,n       .^•_^.    .^^     |,^^,    ,^^^^,^.    |.^^_.    ^.^,,^^._^    ._,.,^,,.   .,|,    ;.i^j,,,^,   ^j^,,,^   ^f    j^ 

lia\e   liccn    rem<i\fd    li.\'    medical   trt-atnient.     Tests   of 
...  c     I  1-  tlie  Mood  will    re\eal    its  i)rosence  when   it   cannot    lie 

Diagram.      Svphihs    germs    in  ' 

bloiiil-ve.ssels.  detected  liy  aii>'  otliei'  means. 

The  four  charts  wliich  follow   illustrate  jiiclorially   some  of   the   lesions  of 
Hereditary  Sy|)hilis. 

Cliarl  ,").-  (See  I'lale  IX.  I 
rhol,.gi:.pli.  Hereditary  Syphilis  of  the  skin  of  a  haliy's  leg. 

Svpliilis  in  a  woman  who  contracted  the  disease  on  the 
thnmh  from  handliiii:  a  l>aliy  with  hereililary  .syphilis. 
The  sore  on   the  thnmh   (a  chancrel   was  the  first  evi- 
Photograph.  dence   of    the   .lisiasc   and   six   weeks   later   sjKjts   like 

those  on  the  forearm  hroke  out  on  the  skin  over  the 
whole  liody. 

.V  syphilis  sore  on  the  ujiper  liji  in  a  i:irl  of  l.>  years. 
Photograph.  who  caught   the  disea.se  by   kissing  a  hahy   who  had 

hereditary  sy])hilis. 

„,    .  ,  Ilcreditarv  Sviihilis  of  the  skin  of  a  haliy's  leg.      Babies 

rhotograpli.  .  ',  ,.  i-ii       r  i        i  j- 

havmg  such  a. severe  form  ot  thedisease  nearly  alwaysdie. 

Cliart  (1.— (See  Plate  IX.) 

Photograph.  Hereditary  Syjihilis  of  the  tongue  in  a  seven  year  old  boy. 

Hereditary   Syphilis  which  has  caused  destruction  of 
Photograph.  jJ^P  py^^   „ost._  ^^1  f^ee. 

„,   ,         ,  Hereditary  Svi)hilis  causing  blindness  in  a  15  year  old 

rhotograpli.  .       .  i  c^ 

boy. 

Hereditary  Syjihilis  showing  the  effect  of  the  disease 

on  the  jiernianent   teeth  of   an  eleven  year  old  boy. 

Photograph.  rpj^;^  jjatient  also  has  an  outbreak  of  syphilis  in  both 

eves  and  in  a  bone  of  the  leg. 


The  ^hilis  Germ 

r        flA,B.CJiaE,-nil!OBIiH 

BMAamnED  noo  tihe& 
.AirpwF.aa4Si»TniB 

This  CDritsatw  shaped  ^mn 
is  the  ouse  cf  9^hitis.  II  iixvwks 


lent  fly  direct  a>nlact  with 
a*s^iUtic  sore.  It  is  most 
often  oonveyed  during  ill- 


13  ftcquenlly  due  to  mouih- 
to-nouth  kisan^  The^mnis 
aometimes  carried  to  an  inn- 
oomtperBOQ  on  toweUrazom 
diiokin^  oj^  etc  wtuch  haw 
been  undlgr  some  one  Invinrf 

Miife  ina  cmita^iDiis  ibmi 
■Invs  RuiiB  brlMV  the  body 
fer  mn  afler  all  visible -si^ 
<f  t  Im  ban  RinoKd  briK^aa 
tiatnait'MsarflieHoodmU 
meal  la  nesenoe  when  it  cnuKt 


Heredilaiy  Chilis 

of  the  ton^  in  a  smrnynr 
old  boy.  ' 


Hereditary  Syphilis 

wtiicii  has  c&i:3cd  distrudion 
of  the  eyes,  nose  and  face. 


Hereditaiy  Syphilis 

cauain^  blindness  in  a  15  year 
old  bqt 


Hereditaiy  Syphilis 

Showing  the  effect  of  Uw  disenseon 
the  permanent  teeth  of  an  clewn 


Heredilary  Syphilis 

orUKskinofatals^k^ 


atatgr  with  hen«tanr  ^rphllia.  ! 
The  mai  the  thnbla  dinar)  ; 
MaUcilntoiiieKcorthediaeaK  ' 
ari  six  weks  Wer  >|«ils  Hbe  law 
an  the  bnami  broke  oat  on  the  ; 
•kin  OKT  the  whole  bod$c 

lijsoieoolheuiiwt 
Har6>t«n,»hcai01- 
Ir  Uaaii^  a  fcdv  who    ; 
tad  htraUfany  wphilB. 


Btmlilaiy  MiiUa  of  (he  akin 
afahaivkk*  Aabieshavii^ 
~"  -  ame  fena  ar  be  «*e«e 


Hereditary  3yphilis 

of  both  kn«s  in  a  boy 
He  also  has  syphilis  of 
the  eyes. 


Hereditary  ^hilis- 

ftrtial  Blindness  and. 
skin  eruption. 


Syphilis  in  an  adull  con- 
tracted innocently  from  bein^ 
tatlooed  by  a  man  who  hnd 
syrhili&'Ihc  syphilis  imns  from 
the  9p(iillK!5  mouth  wrrc 
carried  on  the  laUoo- needle 
into  the  pnlientis  skin. 


Pl.\te  IX  Section  A.  O. 

HEREDITARY  SYPHILIS.     THE  SYPHILIS  GERM  AND  CHARACTERISTIC    LESIONS 


.■52 


DIRECTORY  AM)  CATAUHiVE  OF  EXHIBITS  \V^ 

Chart  ?.— iSfi-  Plate  IX.) 

Hfro(lit;irv  Svi)liilis  of  hotli   knees  in  a  how      He  also 
P  loliiL'rap  1.  ■         ^.       1  •'■•       "r  .1       I' 

'^    '  lias  Syphilis  of  tlie  Kyes. 

Ph(.tc>'rii)li  Ilernlilary  Syjiliilis.      I'arlial   Blindness  and  skin  erup- 

tion. 

Syphilis   in   an   adult   eonlraeted   iiuioeeni  !>■  fi'oni  heing 
pi^^,^  ,i..    Ii  tattooed    hy  a    man   who    had   syphilis.      The    syphilis 

irernis  from  the  .syi)hilitie"s  mouth  were  carried  on   the 
tat  too-neeille  into  the  patient's  skill. 

Cliarl  S. 

Permanent  deformity  of  the   nose   due   to   destrnetion 
'"  "*-''''!"■  ,,f  il,,.  |„,nes  in  the  nose  liy  Hereditary  Syphilis. 

I'erniani'nl    scars   of    the   iaee   following    sores    due    to 
'  Jlerechtarx'  ^yphihs. 


I'hotdgrapli. 


Heredilar\'  Syphilis  in  a  yount;  nirl.      The  disease    has 
dcstroyc(l  one  e\('.  (he  nose,  and  pari  of  Ihc  lip. 


Hereditary  Svphilis  of    the  finuers.     .\   <()nnnon   form 
^    '  oi  tlie  disca.sc. 

An    .r-ray    [)ieture    of    the    forearm     of    a     .")-year-old 
Pliiilograpli.  child.     The     hones     show     the     etfecl     of     Hereditary 

Syphilis. 

The  arm  hone  from  a  hoy  18  years  of   ajje  who  died 
PIiutdKrapli.  of  Hereditary  Syphilis.     The  disease  also  affected  other 

bones,  joints,  and  internal  organs. 

Cliart  I).— OtliiToffcTts  of  lii-rrdilary  ^y|>llilis. 

Hertnlitary  Syphilis  is  a  crippliuu  and  life-destroying  blood  di.sease  iidier- 
ited  from  one  or  both  parents. 

The  more  dangerous  forms,  which  camiot  be  well  shown  in  pictures,  may 
affect  the  brain,  liuigs,  liver,  heart,  blooil-vessels,  sjHnal  cord,  nerves,  and 
other  \ital  parts. 

Hereditary  Syphilis  eau.ses  many  babies  to  be  born  dead.  Very  often  thi.s 
disease  does  not  show  any  visible  signs  luitil  the  liaby  is  from  two  to  six 
weeks  oM. 

Of  the  babies  born  alive  with  hereditary  syjihilis,  many  die  in  spite  of  the 
most  carcfid  treatment.  Hereditary  syi)inlis  renders  children  easy  jjrey 
for  other  diseases  which  often  result  in  death.  Once  gotten  under  control, 
the  disease  can  be  cured  by  medicine  given  for  years  under  a  j)hysician's 
direction. 


34         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Heredity  and  Eugenics 

This  booth  contained  the  following  legends  and  graphic  charts: 

Section  A.     Booth  No.  1. 


Alcoholism  can  scarcely  lie  placed  in  its  proper  relation  to  other  causes  of 
excessive  Infant  Mortality  imless  it  is  regarded  as  a  part  of  a  vicious  circle, 
of  which  Ignorance,  Carelessness,  and  Poverty  form  important  parts. 


INFLUENCE  OF  ALCOHOL  ON  INFANT  MORTALITY 
Table  Showing  the  Progressive  Death  Rate  in  Alcoholic  Families 

Dead  and 

Dead  and          Dead-bnrn.  Dead-Born 

Cases          Dead-born         Pereeniayc  Percentage 

First  Ijorn 80                   27                    33.7  (i.2 

Second  born 80                   40                    50.0  11.-2 

Tliird  Ijorn 80                   4'2                    52.0  7.6 

Fourth  and  fifth  born Ill                   73                    65.7  10.8 

Sixth  to  tenth  born 93                   67                    72.0  17.2 

Influence  of  Alcohol  on  Infant  Mortality 

Xo.  of  Chil-  Percentage 

Xn.  nf               Xo.  of       dren  Dead  in  of  Dead 

Mothers           Children         i?  Years  Children 

Driinlvon  mothers 21                      125                  69  55.2 

Sobermothers 28                     138                  33  23.9 


The  Mating  of  the  Unfit 

The  Law — The  Cost 

No  Escape  From  These  Laws 

One    parent    neurotic,    insane,    ei)ile])tic,    feeble-minded,    imbecile,    will 

produce  some  children  likewise  afflicted. 

Both  parents  liaving  such  diseases,  all  the  children  must  suffer  in  the 

same  manner. 

The  children  of  alcoholic  parents  are  often  feeble-minded  or  degenerate. 

Syphilis,  a  race  poison,  is  transmissible  in  the  blood,  even  to  the  second 
generation. 


DIRECTORY  AM)  CATALOGUE  OF  EXHIRITS  So 


The  standard  of  home  life  must  !)(•  raised.  Fatherhood  and  motherhood 
must  he  entered  upon  with  (hie  reco^nilidii  of  the  moral  duties  and 
responsil)ihties  entailed. 


Effect  of  Povkkty  .\ni)  I.nsiff 

iciK.NT  Food 

Of  357  infants  dead  from  all  causes,  :,  per  ecnl 

(if  the  mothers 

lived  in  a 

pernieious  social  environment,  and  in  addition 

here  were  niark( 

(1  poverty 

and  insulheiency  of  food. 

Of  111  infants  dying  from  immaturity,  10  per 

■cut .  of    the  iiKil 

hers  were 

in  extreme  povert.v  and  insiiflicicncy. 

Effect  of  III  Ukaltii  ok  ^Iotiikh  on  Infant  Mohtalitv 


Of  3o7  infants  dead  of  all  eaiises,  ;>!)  per  cent,  of  the  mothers  had  a  history 
of  ill  health  duriiii;-  and  before  prefiiianey. 

Of   111   infants  d,\ini;'  from   iiiimal  iirit.v.  .">.")  per  cent,  of  the  nK)thers  were 
physically  unfit. 


The  be 

st  test 

of  a  civi 

ligation,  a 

culture. 

or 

an 

inst 

itution, 

is 

whether  it 

eontril)uted  to 

I)roduce 

good  child 

ren,  well 

en 

lowed, 

and  to 

ad\ 

ance  them 

to  their 

fullest 

possible 

maturity. - 

-Hall. 

"Much  mone,v  is  spent  on  special  schools,  special  institutions,  asylums, 
homes,  and  special  hospitals;  every  device  is  resorted  to  to  cure  what  we 
ought  to  have  tried  to  prevent  years  ago." 


We  have  the  census  figures  showing  infants  killed  b.v  preventable  diseases. 

How  can  we  obtain  the  long  list  of  the  babies  iruunded  for  life  by  prevent- 
able diseases.^ 


36         REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOJJ' 


Eugenics  Means  a  Better  Crop  of  Boys  and  Girls 
The  function  of  Eugenics  is  to  produce  a  race  healthy,  well  formed,  and 
vigorous  by  keeping  the  springs  of  heredity  pure  and   undefiled,   and 
improving  the  inborn  qualities  of  the  offspring. — Morroxc. 

We  Study  Agriculture  and  Household  Arts  to  find  out 

How  to  raise  better  crops  of  wheat, 
How  to  improve  the  breed  of  cattle, 
How  to  hake  better  bread. 
How  to  produce  material  wealth. 

We  should  also  study  Eugenics  in  order  to  know — 
How  to  endow  childhood  with  its  Birthrights  of  wholesome  instincts  and 
vigorous  life. 

How  to  prevent  conditions  that  now  l)light  and  handicap  thousands  of 
children  before  birth  and  throughout  life. 
How  to  improve  the  race-stock. 
How  to  produce  Human  Wealth. 


The  child  l)orn  maimed  and  Ijlightcd  is  cheated  of  its  birthright,  being 
robticd  of  i)ower  for  normal  growth  and  development,  and  made  to  bear  a 
terrible  burden  of  unhappiness. 


There  is  no  case  on  record  in  which  two  imbecile  parents  ha^•e  produced 
a  normal  child. 

Illustrative  Diagram 


If  half  the  money  exj^ended  now-  had  been  spent  on  the  Mother,  the  Child, 
and  the  Home,  over  ^20,  10,  or  even  5  years  ago— our  special  schools  would 
not  be  so  urgently  needed. 


Registration  of  Births 

Have  you  made  personal  incjuiry  as  to  whether  your  birth  and  your  chil- 
dren's births  have  been  properly  registered? 


nrniy  roRV   i.v/)  ( Ar.ir.oari-:  or  exhibits  37 


Aloiiu  willi  ^ypliili-  niil-l  1)C  |il:i(  rd  al(i)lH>li>iil  us  ;i  mtIdUs  cmusc  of  liilaiit 
Mortalitv  .  I'arciital  iicf;lcct  is  a  coiiimoii  rcsiill  nf  alcdliolii-  liahits,  and 
lliis  iiii|)lic.s  a  liigli  rato  of  mortality  among  rliihlrcn  atiVctcd  t>y  sucji 
neglect. 


("orxT  Tin;  Cost  in    rin.  I'mtki)  Sr\TKs 

liViiiiliirss. 

In  ililani-.  under  out'  year    7,:i('(!) 

Cost  of  Institutions  for  all  Mind $1, .>().•>, S(l() 

Deofnrs.s  and  Diniihiicss. 

Individuals  who  are  deaf  or  diinil>  or  Kolli           .  S!),-2S7 

Cost  of  schools  for  deaf  and  dnnil) .S:>..'i.JO. ()()() 

Fcehlr-iiii)i(l('(l>ir.f.'<  mid  I mliccililji. 

Feelile-minded  in  instilnlions IS. 1-7(1 

Cost  of  their  .'are .'i54,.'{S !.:!<)  1 

Estimated  not  in  institutions 'JSS.dOd 

All  a  nieuace  to  the  race  and  nation  through  conduct,  crime,  and  ])roi)aga- 
tion  of  their  kind. 

Some  States  now  i)roliil)il  the  marriage  of  insane,  epileptic,  feehle-minded, 
alcoholic,  syphilitic,  and  criminal  persons. 


If  we  neglect  the  moral  aspect  of  the  res])onsiliilities  of  parentage,  and 
especially  motherhood,  we  must  i)ay  the  penalty  of  racial  decay. 


The  architect  may  achieve  a  heautiful  house,  a  convenient  dwelling,  or  a 
money-making  skyscrajier,  but  unless  he  has  first  in  each  case  achieved  a 
building  healthful  for  its  occupants  he  has  failed  in  what  should  be  his 
highest  aim. 


DIRECTORY  AXD  (AT.lLOarK  OF  EXHIBITS  .'5!) 


The  conditions  tiiat  kill  one  out  of  five  babies  also  maim  tiie  other  four. 


Section  A.     BiHitli  Xo.  i.     iSiv  VUU-  X.) 

Infant  Afortality  In  Relation  to  Feedini;  and  Poverty. 

Cir;ipliic  (  hart. 

Breast  Fed  Babies  have  a  far  better  chance  of  liviiiir  lliaii  IIiom'  fed  by 
hand,  wlietlier  in  very  jiuor  families  (ir  in  tlinse  a  lit  lie  iiellcr  utl'. 

Infant  mortality  rates   per   10, 000  births  ainoni;  ille<iitiniate  and  legiti- 
mate children  in  l,ondi)n  and  certain  rural  counties  in  1!)0'J. 
(iraj)iiir  <  "liart 

Causes  of  Infant  Mortality. 

(iraphic  Cliart. 

Classifieation  of  the  causes  of  44,'-2'2()  deaths  under  one  year  of  aj^'e  in  New 
York,  Philadelphia,  Boston,  and  ('liica>;o,  190!). 

r.rai)liic  Il.n-,iit.v  Cliarl  of  KTiuna  \V.  ISnm  I'.l.niary  II.  |SS<). 
Ennna  W.  came  to  life  in  an  almshouse,  stamped  with  illegitimacy  and 
feeble-Tiiindedness.  Her  family's  record  reads:  mother,  two  l>rotliers, 
and  a  sislt>r  feeble-minded;  mother's  father  feebl(>-minded  and  mother's 
mother  tuiierculons.  When  a  .second  child  was  expected  the  mother  was 
induced  by  well-meaniui;  i)eople  to  nuirry  the  father,  who  was  a  drunken 
epilei)tic.  Two  children  were  born.  Still  lat(>r  the  same  well-meaninj; 
people  aided  her  to  oet  a  di\"orcc  in  order  to  marry  the  father  of  another 
child  about  to  be  born.  Since  then  foiu'  more  lia\'e  been  born.  .\11  of 
these  children  are  feeble-minded.  The  entire  family  with  the  e.\cei)tiou 
of  the  oldest  child  is  at  large. 


Housing'  and  Environment 

The  two  booths  relating  to  Housing  and  Environment  contained  the  following 
charts  and  ])hotographs.  The  purpose  of  the  charts  was  to  emphasize  the  condi- 
tions which  connnonly  endanger  the  lives  of  infants  and  children,  and  to  place  the 
resi)onsibility  for  their  correction.  The  photographs,  each  of  which  bears  an  ex- 
planatory legend,  represent  actual  conditions  in  Philadelphia — conditions  which 
are  a  menace  to  the  health  of  her  infants  and  children,  and  which  nuist  be  corrected 


House  E. 
House  F. 


-  1309 

«  "-         -  '91* 
Sister  -  1911 

BnAher  —  1908 

—  1910 

Sister  —  191 1 


EEcJwvated  oaeye 
No  recond. 


Scfused  bjr  father 


' 


Mother  -  19U.       Son  -  ••    ■»  - 
Kilher  -1312       sc  *SjB,(s.,ii4 


Plate  XI 

CHARTS  SHOWING  THE  RESULTS  OF  HOUSE  INFECTION  WITH  TUBERCULOSIS  AND  THE  EFFECT 
OF  OVERCROWDING  AS  A  CAUSE  OF  INFANT  MORTALITY 

40 


DinECTORY  AXD  CATALOGl'F.  OF  EXHIBITS  41 

by  co-o])er;iti()ii   Ijetwecu   the  health  autlioritii-s  of   tlie  city  of   I'liiladelphia  and 
her  citizens. 

Section  A.     Booths  \os.  ;i  and  4.      (Spc  Phitrs  XII.  XIII,  iiikI  XIV.) 

Cliarls. 


Cities  having  the  most  efficient  service  for  tlic  removal  of  waste,  show  the 
lowest  Infant  Mortalitv  from  Diarrlid'al  diseases. 


Diarrh(ra  is  most  jjrevalent  when'  the  systems  of  removal  of  sewage  and 
house  refuse  are  least  satisfactorv. — .Xnr.shdliiic. 


Evidence  stronjily  jjoints  to  the  fact  that  in  many  cases  infantile  diarrlura 
is  due  to  surface  accniiHilations  of  ofi'ensi\e  maleriai  in  I  lie  \icinity  of 
houses,  open  garl)age-cans,  garijafie  duni])s,  oriranic  refu-~c  in  hack  yards, 
alleyways,  streets,  "utters,  and  open  pri\y  wells. 


The  resjionsibility  for  a  large  portion  of  the  total  infant  mortality  and 
of  the  total  mortality  from  infantile  diarrluea  must  he  home  hy  sanitary 
authorities. 


Cities  with  a  high  tcmj)crature  duriTig  the  summer  months,  and  a  deficient 
rainfall,  sln>w  a   high  death-rate  from    Diarrhn-al    Diseases    in    Infants. 


It  is  not  so  much  a  f|Ucstion  of  making  new  or  more  adequate  sanitary 
laws,  health  ordinances  or  police  regulations  to  ])rotect  the  health  and  life 
of  children:  as,  the  ap])licati()n  and  strict  enforcement  of  existing  laws, 
ortlinanees  and  ])olice  regulations  and  the  earnest  co-ojieration  of  the 
jjcople  assisting  the  authorities  by  obeying  them. 


42         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


"Wlierever  tlic  health  of  the  citizens  is  concerned.      .      .  all  governments 
that  are  not  chimerical  make  haste  to  interfere." — Carhjle. 


No  strict  line  can  be  drawn  between  miiniciiial  and  jjarental  responsi- 
bility for  uncleanliness  which  makes  for  loss  of  infant  life. 


Domestic  cleanliness  has  not  a  fair  chance  so  long  as  the  continuance  of 
privies,  surface  drainage,  dirty  streets  and  other  insanitary  conditions 
are  permitted  to  exist. 


Infant  mortality  is  only  a  statistical  expression  of  the  bad  conditions 
Ijy  which  Infant  Life  is  surrounded. 

The  little  babies  who  die  are  dead  and  gone,  l)nt  the  conditions  that 
have  caused  their  deaths  remain,  and  will  tend  to  make  thousands  of  other 
children  grow  u|)  infirm  or  defective  and  deficient  in  some  of  the  physical 
needs  of  a  full  life. 


The  main  reasons  for  the  persistence  of  a  high  infantile  mortality  arc 
undoubtedly  tiie  want  of  ])ropcr  maternal  care,  the  increase  in  the  artifi- 
cial or  hand  feeding  of  infants  of  suckling  age  and  insanitary  environ- 
ment. 


Efficient  and  active  house  to  house  sanitary  inspection,   and  repeated 
re-inspection,  are  important  factors  in  reducing  Infant  Mortality. 


Children  are  the  truest  indices  of  the  sanitary  condition  of  a  crowded 
neighborhood. 


DIRECTORY  AM)  CATAUXiVK  OF  EXHIBITS  43 


No  amount  of  effort  will  eradicate  tuberculosis  and  other  infectious  diseases, 
nor  prevent  physical  and  moral  degeneration  among  city  and  town  dwellers, 
unless  the  lioiising  ((uestioii  is  attended  to  first  and  foremost. 


Polluted  soil  often  gains  access   into   homes  as  a    line  dust   and   jxiisons 
food. 


Alcoholic  liahits  ohviously  lend  to  I'dxcrty.  and   to  a  direct  lowering  in 
the  Standard  of  Life;  especially  in  relation  to  food  ami  Imusing. 


Conditions  dlk  to  IxtLEAN  Habits  wiih  ii  may   Kndanckk  th?: 

Life  of  a  Child 

1.  Filthy  homes  due  to  laziness. 

2.  Personal  uncieanliness. 

3.  Dirty  cellars,  hack  yards  .ind  alleyways. 

4.  Rnhhish  and  garbage  in  alley,  hack  yard  and  gutter. 

5.  I'ncovered  garbage-can. 

6.  Soiled  privy  or  water-closet  seats  and  floors. 

7.  Uneoverccl  privy  .seats. 

8.  Keeping  of  nudean  domestic  pets  (dogs  and  cats). 

9.  Soiled  clothing  and  hcdding. 

10.  Unwashed   dishes  and    partially  eaten   food   lying  ahout   exposed   to 
flies. 

1 1.  Improper  care  of  food. 

\-i.  I'sing  of  drinking-cuiis.  glasses,  and  eating  utensils  that   have  not 
])een  washed  and  scalded  since  their  use  l)y  others. 

l.'i.   Handling  of  towels,  handkerchiefs,  and  napkins  used  by  some  one  else. 

14.  Tasting  of  food  before  gi^■ing  to  the  baby. 

15.  Unscreened  windows  and  baby  crib  (keep  out  flies). 

16.  Spitting  on  the  floor. 


44         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


Prevention  of  Infectious  Diseases  rests  on  a  knowledge  of  their  causes, 
their  mode  of  spreading,  and  the  more  accurate  and  complete  this  knowl- 
edge, the  more  effective  becomes  our  Prevention. 


Conditions  due  to  Bad  Housinc;  which  may  Endanger  the  Life  of 

A  Child 

1.  Indifferent  owner  or  landlord  of  premises. 

2.  Insufficient  jiure  water  supply. 

3.  Bad  i)lunil)ing  and  firoken  drainage  pi])es,  surface  drainage. 

4.  Lack  of  sunlight,  rcntilaiion,  and  J  re  sh  air. 

5.  Overcrowding  of  Ijed-rooms  and  sleeping  rooms. 

6.  Badly  constructed  buildings,  unlighted  and   unventilated  halls  and 
stairways. 

7.  Inadequate  fire-escapes. 

8.  Damp  and  undrained  cellars. 

9.  Surface  drainage  in  alleyways  to  street  gutters. 

10.  Location  of  homes  near  open  manure  ])its,  cow  stables,  slaughter-houses, 
pig-pens,  dump  heaps,  swam]js,  open  privies,  street  curb  and  sidewalk 
markets,  unscreened  meat,  vegetable,  and  fruit  market  stands. 

11.  Unscreened  windows  and  doors  of  homes. 

12.  Insanitary  condition  of  streets  and  neighborhoods. 

13.  Broken  brick  pavements  on  sidewalks  and  in  alleyways. 


DIRECroRY  A.\D  CATALOGUE  OF  EXHIBITS 


Conditions  Due  to  TuofcHTLEssxEss 
WHICH  MAY  Endanger  the  Life  of  a  Child 

1.  Taking  children  into  homes  or  places  where  there  is  sickness. 

2.  Attending  funerals  of  tiiose  who  have  died  from  any  doul)tful  or  con- 
tagious disease. 

.'?.  Sending  children  who  are  slightly  ill  to  school,  Sunday-school,  kinder- 
garten, dancing  classes,  parties,  or  allowing  Iheni  to  l)lay  or  mingle  with 
other  children. 

■1.  Taking  children  into  crowded  places,  overcrowded  si  reel -cars,  moving 
picture  shows,  curl)  or  street  markets,  on  tiresome  journeys,  excursions, 
or  kee|)ing  children  \l\^  laic. 

5.  I'ermitting  children  lo  play  in  ash  heaps.  duni|)ing  gi-ounds.  dirt,v 
hack  .yards  or  alleys  in  the  \icinily  of  maiuire-pils,  slatighter-houses, 
piggeries,  or  wherc\-er  there  is  filth  or  unhygienic  surroundings. 

fi.   (iiving  the  haliy  I'oikI  Ihal  lias  li<>cn  previously  tasted  hy  others. 

7.  Exposing  the  hahy's  eves  lo  I  he  direct  ra\s  of  |hc  sun. 

8.  (iiving  children  candy,  hokey-pokey,  ice-cream,  heer,  hananas,  lea, 
eotfee,  cakes,  or  other  iiii|)ropcr  foods  for  infants  ;ui<l  children. 

9.  The  use  of  feather  dnslers  oi  IJic  cnsluni  of  dry  sweeping,  and  .--weeping 
or  dusting  when  Ihe  \)n\\\  is  in  I  he  room. 


Insect  Carriers  of  Disease  which  may  Endanger 

the 

Life  of 

A     C 

hii.d 

Flics. 

Mos(|uitoes,  1 

edhugs,  Fleas, 

Ti.ks 

Flies — Summer 

Diari 

lupa.   Anthrax 

,   Cholera,   Dy.sentery 

,   Sore   Mouth, 

Plague,  Sore  Eyes, 

Trachoma,  Tu 

lerculosis,  Ty 

ihoid  F 

L'ver. 

and  other 

disea.ses. 

Mosquitoes — M 

alaria 

,  bellow  Fever 

Infected  An 

IMALs 

WHK  H    MAY 

Kndanger  the  Life 

of  a 

Child 

Domestic    Pets- 

-Cat 

-     and     Dogs  - 

Rats,    Mice, 

Horses 

Pig 

S    Cattle, 

Sheep. 

Cats   and   Dog? 

— Ra 

lies,   Diiihtheria,    and   other 

Contagious 

Diseases, 

Skin  Diseases  and  Worms. 

Rats  and  Mice- 

-Plague,  Worms. 

Pig.s — Trichinos 

is. 

Cattle.  Sheep- 

Ant  hi 

ax.  Tuberculosis,  and  other  d 

isea.ses. 

46         REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 


Breeding  and  Feeding  Places  of  Insects 

Flies — Horse  manure,  cow  stables,  manure  storage  piles,  stables,  piggeries, 
pig  manure  piles,  pure  loft  dumping  grounds,  i)rivies,  decayed  food,  fish, 
meat,  offal  from  slaughter  houses,  garbage,  dirty  alleys;  fruits,  vegetable 
market  stands;  organic  refuse  found  at  street  and  curb  markets.  Un- 
screened candy  and  cake  shops. 

Mosquitoes — Swamps,  dirty  ditches,  water-tanks,  water  in  vacant  lots, 
open  water  traps,  damp  cellars,  unused  sinks,  ]>ools  of  stagnant  water, 
surface  drainage  in  allej-s,  unused  buckets,  cans,  and  otlier  recejitacles 
containing  water. 

Bedbugs,  Fleas — In  houses  and  homes  that  are  dirty,  unclean,  badly  ven- 
tilated, and  domestic  pets  (cats  and  dogsj  when  kept  in  a  filthy  condition. 


Flies  Carriers  of  Disease 

It  has  been  positively  proven  that  flies  are  frequent  carriers  of  disease. 
They  may  carry  germs  in  one  of  two  ways:  infected  material  on  the  head 
and  legs  may  be  deijosited  on  the  food,  or  the  germs  may  be  swallowed  by 
the  fly  and  deposited  later. 


Flies  Breed  in  Filth 

AH  the  strenuous  efforts  suggested  to  destroy  or  catch  flies  amount  to 
almost  nothing  as  comi)ared  to  the  residts  obtained  from  an  active  and 
well-planned  sanitary  campaign  directed  against  their  breeding  places. 


Photographs. 

1.  2. 

Female    House    Fly   resting   on  Male  House  Fly  resting  on  glass, 

glass,  seen  from  above.  seen  from  below. 

Showing  the  six  muscular  legs,  at  the  end  of  each  of  which  are  two  claws, 
and  two  sticky  jiails.  to  which  germs  and  filth  adhere  and  by  which  they 
are  carried  from  j)lace  to  ))lace. 

The  best  way  to  destroy  the  flj'  is 

to 

REMOVE  THE  FILTH 

Alleyway  between  Snyder  Ave.  and  Jackson  St.  One  row  of  houses 
underdrained. 

The  op]iosite  row  has  no  sewer  connection,  no  sewer  in  street  to  connect 
with. 

Broken  ])avcnient,  garbage,  and  refuse  carelessly  thrown  aliout. 
Flies  and  mosciuitoes  abundant.     Odors  of  decayed  garbage  and  filth  per- 
meate the  atmosphere. 


DIRFATORY  AXP  CATALoarK  OF  FXIURFFS  47 

Italian  Court.      Entraiic(>  throtiiili  surfa(0-(lraiiic<l  alleyway. 
I'rivy  vaults  in  insanitary  condition. 

Surface  Drainage  and  Open  Pri\y  X'ault.      Child  playini;  in  alleyway. 

Filthy  Privy  \'ault.       Mroken  i)riek  pavement,  scattered  jiarliaiie   and 
refuse,  flies  swarming  in  vast  numhers.     Kitchen  ten  feet  away. 

Dark  allcyua>-.  Home  of  four  families.  No  sunliahl  ami  Init  little  fresh 
air.      Hrokcn  hrick  pa\ciricnl. 

The  privy  vault,  the  sm-face  drained  alleyway,  and  the  earhage  huckel, 
are  in  the  majority  of  eases  near  neiuhhors  to  the  "  I?aek  Kitchen." 
Filth—  Flies.  Kitchen.  l'\)od,  Disease. 

Backyard  of  rcsidi'ucc  in  South  Philadelphia.  Showing  overflow  from 
privy  well,  stagnant  ilihli  \\;ilcr.  refuse,  and  garliage.  Pulilic  school 
liuilding  in  hackgrouiid. 

Surface  drainage. 

Siu'facc  di'.'iinage  water  and  till  h  |-unning  through  alli'y  lo  street .  Prokeil 
l)i-ick  pavement  ;    refuse  and  fill  h  in  gull<'r.  street,  and  <in  sidcw  alk. 

\\  here  some  of  the  hokey-pokey  carts  are  housed.      Surface  drainage. 

Municipal  Dust. 

Dry  Sweeping  of  I'ulilic  Streets. 

Showing  open  manure  cart  standing  in  the  sun  for  a  j)erioil  of  two  hours. 
.Manure  uncovered  and  flies  swarming  in  vast  nnmhers  ahout  the  cart  and 
its  contents.      (Pith  and  Pine  Sts..  I'hiladel])hia.  P2.;!0P.  ^L) 

Showing  |)ile  of  manure  on  street  sidewalk. 

Booth  sliowing  o])en  unscreened  manure  pit. 

Herd  of  slice])  lieing  <lri\en  o\"er  the  sidewalk  in  one  of  the  ])rincipal  resi- 
dential sections  I  Locust  and  l.jthSts.).Philadel|)hia,at  lO.V.^P  The  side- 
walk was  littered  with  niamu'e  and  dirt;  ])edestrians  tracked  this  material. 
It  was  necessary  for  the  occu[)ants  of  ]n-emi.ses  to  remove  the  tilth  and 
clean  the  sidewalks.      (May  1.'),  P)1^2.) 

Cooked,  smoked  and  raw  meats  for  sale  on  street  curl).  Exposed  to  flies 
and  street  dust.     Better  grades  of  meat  under  glass. 

Cleaning!;  fish  on  street  curb.  Scales,  entrails,  and  piece.s  of  fish  have  been 
thrown  into  the  gutter.  Street  littered  with  filth  and  refuse.  (The  dark 
sjiot  in  the  street  on  the  lower  left-hand  corner  is  the  material  thrown 
away  hy  the  fish  cleaner.)     Public  school  on  op])osite  corner. 

Poultry.  Meat,  Sausages  and  Pickled  Meat.  Exjiosed  to  the  street  dust 
and  sun — and  sold  at  a  curl)  market. 


■QKes  hawQft  (hemost  rfRaent 
service  fcr  the  removal  of  waste, 
show  the  lowest  Inlanl  " 
from  Diarrtweal  diseases."  I 


and  rffW  wfcnmwrt  of  ocislH^  bwk  enfr 
nananoes  and  polkf  reflations  aiid  Hie 
exnest  cooperation  pf  Itr  pet^  assidiog 
fitt  authorBies  b^  obevinf;  (hem. 


Undean  Hal 
pndanserthei  

.  FilHo'  homes  du?  lo  laiinoss. 
i  ftraoial  uticteanliness. 
J  Dirfy  cellars,  hack^^nis  _i  ^e/v^ 
4.  RuUisli  1  ^Hngc  in  aUrK.  bxkyinl 
and  gulter. 

5  UiKnered  jjHMjE<an. 

6  SoiM  pnyy  x  waler<lo3el  xab  and 
fhm 

Z  l/miwwi  pwy  seats 


i  bedding. 

lecpimlkpnes. 
p^  caie  of  ibod. 

l2.U!irSi)fdni*inJaip5.Jlas!M.-o*8 

ulBMls.  thai  ha*  irt  b»n  washed  and  . 

^xalded  siiratliariwiycllKra.      % 

llandlinj  rf  towsfe  handkart**!  wdji 
^tB|]bns.  used  bf  sowooe  ^ 
.Ta5lin8offaxlb*n!8iv(i«ki 

is.  Ulscmroi  windBO  and  hl^ 
(keep  out  (teJ  | 


active  hoose  to  barsB 

on.aiid  [Tjiealod 
I    "H-iiBiiedion.  are  important  factors     j 
;    in  reducing.  Iij&iil  Mortalil)'.' 


Tiie  main  nasuiK  SrUe  [n3i*m 

;  cT  a  high  irfanlilc  xiamx  an>  undouU 
^  edly  the  want  cf  proper  m^enial  cait. 
|Bv  iKiraii!  in  tie  artificial  or  hand 
lhdil«  if  inlanis  <f  sodding  ^  and 


Plate   XII 

CHARTS  AND  PHOTOGRAPHS  RELATING  TO  HOUSING  AND  ENVIRONMENT 


48 


DIRKCTORY  AM)  (  ATAUK.UE  OF  EXHIBITS  49 

Filtli  and  market  rofuse  and  lien  scavenger. 

Manure,  garhaye  and  refuse  and  trimmings  from  fisli  and  meat  niarlvels 

pile(l  in  street.     Flies  in  threat  numl)ers. 

Tiie  same  street  six  hours  alter  the  Maiket  Carts  ha\-e  l(^ft. 

Chicken  butcher  shop  on  sidewalk.     Next  door  to  a  <lry-j;o()ds  store. 

Filth  and  refuse  thrown  into  a  street  in  Soulii  ]'liila(lel|ihia. 

Curl)  market .      \'ei;etal)les.  Fruits,  15iea<l,  Cakes,  and  Dry-u'oods. 

Live  eliieken  market.     Chicken  crates  piled  in  gutter  and  on  .--idewalk. 

Vegetable  and  fruil  slreel-cu?-b  markcl.      T'hiladelphia. 

The  curb-slonc  food  cart.      I'"ood  exposed  to  street  du^t  and  Hies. 

Chicken  market.  (  hickcns  killed  on  sidewalk — blood,  jjieces  of  meat, 
fat,  and  refuse  scatterccl  over  the  ])avement. 

During  her  marketing,  a  careless  parent  lea\c-.  a  baby  on  edge  ot  slrcet- 
curb  next  to  a  basket  full  of  garbage  and  a  dirty  gutter  swarming  with  tlies. 

Cakes,  fruits  and  candies  which  lui\'e  been  exposed  to  tlies  and  street  dust 
and  which  are  sold  to  children. 

A  puni]). 

The  water-su])])ly  for  the  majority  of  houses  in  two  blocks  of  ^\()odeii 

dwellings. 

The  new  houses  recently  constructed  seen  in  background. 

A  conilensed  milk  can  as  a  common  drinking-cup. 

A  Common  Drinking  Cup.  A  dangerous  and  dirty  custom.  It  ma.v  be 
found  in  many  houses,  yards,  school  Iniildings,  ])laygrounds,  ])ublic  parks, 
and  other  i)laees.  Every  person,  especially  the  babj',  should  have  his  own 
drinking  cup  or  glass.     It  should  be  washed  frequently. 

Garbage  hand  cart  swarming  with  flies. 

City  Dumping  Ground. 

Boy  working  over  the  deposits. 

Public  school  in  Ijackgroiuid. 

0])en  lot  near  a  public  .school  where  rags,  collected  from  dumps,  ash-cans, 
houses,  etc.,  are  spread  out  to  dry. 


I'lxwnlion  of  Infedinis  Diseases 
resis  on  a  kiKMbljSe  dWv  mode 
cf  sprealinj  and  llic  more  aoeurate 
and  cnnpli'le  Ihis  knwled^  He  ntn 
(flcctiw  baomej  air  ft      "    " 


Breeding  aiid  Feeding  r 

of  Inseds.  j 


Horse  manure,  cow  stables   ', 
TOnureslorags  piles,  stables    | 
'piggeries,  pij  manun-  pilexdunp- ' 
ing  Smindi  privies.  dfcajwJ  food  ; 
lisli.nimt.o(lal  frem  sJauShlcr 
houses,  garba^  dirtv  alWs:  fruil 
W8*bte,  marW  slai«k  organic 
refiisc  found  at  stiH*  md  curt  mar- 
f^sJkiOTOsd  <»dy-r  alsilop 

bes-Snampsdirb'dilctiEs.iraler 
'-Its.  wafer  in  vacant  lots,  open 
la- traps,  damp  cellars,  umseif 
ks.  poet  rf  stagnant  wafer. 
(acs  drainage  in  aSqys.un-  ' 
d  budo^s.  cans,  and  otiier 
'  '    containing  water. 

I  bugs. Heas-ln  houses »i Junes Ud 
I  dirty  uncieaii.  badjv  wntilalaj 
I  wlw  ifcnieslic  p*  Idj  J  d*) 
MinafilthyanttiDn. 


reedinFillh. 

I  Hw  simiuQiis  efforts  suggested 
■"-^orcateh  fties.  amount  to 
'"^  as  coropatwj  to  the 
_  i  ftwn  an  adiw  and 
sanitary  campaign  diiw- 
.^  Uh*  breedm^  piaoes.' 


Plate  XIII 

CHARTS  .\ND  PHOTOGR.\PHS  RELATING  TO  HOUSING  AND  ENN'IRONMENT 


50 


Diiu'j  Tony  AM)  (  ATAi.oi.n:  of  i:\nfiiiTs  ,->i 

("ow.s  rccdint; nil  ;i  ( 'il y  I  linii])  11  c:!)). 

Sick  ciiw  in  liitli\-  (■(Hidil  ion.  I'ii;  and  cow  iii;iiiii|-c  sIciiimI  in  I  lie  saiiie 
yard.      I'lililii'  scIkkiI  acioss  tiic  sircrl. 

Shiu.niitcr-lioiix-  li)catcd  dii-c<liy  ncxi  lo  "  W  a^ilinL;l<lll  S<-ii()(ii."  I'liila. 
I'igs,  cattle  and  slu'C|)  slaiii;lit('i-c(l  licrc.  I  iiNcrcciicd  windows  of  slaiiuii- 
terinj;  room.     Sheep  confined  in  jk-ii  on  Ironl  sidewalk. 

l'ii;-sties  in  clo^c  |iro\iniily  to  a  I'nlilic  ScIhkiI. 

l'i(;(ii:uiKs 

Sliowint;  liin'^cries.  swanii)  ami  dMiniiini;  yroiind  for  tnaiinre  and  rel'iiso. 
It  i.s  estimated  lliat  there  are ','(),  KM)  pi-s  in  IMiihidelpiiia  lieiow  Hitiier  St. 
and  l)<"t\veeii  llie  Delaware  and  Scliuylkili  l{i\ers.  IJreediiig  firoiind  t't)r 
flies  and  mos(|niloe-..      iMa.w  H)l'-2.) 

.'is  ]>iys  wiM'c  coiifin<'d  on  llie-.e  piemiscs. 

Ojieii     aarhaye     cart   -doi;s,     chickens,     uoats,     jii",'     iiiaiiure     ])ilo — ojien 

jirivv  vault,  no  niiiiiiiiii  water-    public  school  huildint;  in  the  liaekfiround. 

(Phi'ladelphia.) 

Piggeries  within  cil\  limits,  Philadelphia. 
Swine.  Swill.  Swamp.      I'"illli—  Flies! 

Baek-yard  I'ig-peti. 
Near  Taggert  School. 

Showing  insanitary'  conditions. 

Showing  insanilary  conditions. 

Insanitary  t'omlitioii  witliin  a  home. 

Insanitary  .\ttic  Room. 

Flashlight  of  room  without  outside  ventilation.  Small  window  and  door 
open  into  inner  room  and  hallway.  Cooking  an<l  sleejiing  same  room. 
Insanitary  conditions  prevail.     No  sunlight  or  fresh  air. 

(ir;i]»liic  (  liart 

Com])arisoii  of  Exiientlitures  for  Ini]iortant  Munici|)al  Activities  in  Three 
Leadint;  American  Cities. 


52 


DllilJTORY  AM)  <  ATAJJIOL]-:  i)l-   KXlIllilTS 


Exhibit  of  the  H<)usin,ir  Commission,  FhHadclphia 

|Srr  l'lal.'>  XV.  XVI,  X\  II] 

HKAI.'lin    IIOMKS  M AKK  IIK Al.TII Y  I'KOI'I.K 

Socti..Ti  A.    I!.... Ill  No  i; 

This  I  mull  I  i()iil:iiii('<l  iii(>(l<'l-  illiistratini;  ;i  ilclcctivc  cily  l)l()ck  and  a  proposed 
reconstnul  idii.  and  •.nine  additional  cliarls  and  |)li(>t()^'rai)lis  rolatini;  to  housiuf^ 
and  cnx  ironiiicnl . 

M..ilcK  Illu-li;iliii!,'  Coiijirstnl  :niil  Rrroiistniclcd  Blocks. 

(1)  IMiiladclphia    Honsin^'  ( 'onnnission   I?lock  Roconstrnclion. 

'I\v])('s  ol'  Mock-.  I'oi-  coiitjcslcd  iircas. 

TIk'sc  models  show  a  eoniicsled  city  hloek  as  now  hilill  up  and  as  il  slionld 
lie  rebuilt. 

('<inipare  the  old  with  t  he  new  plan. 

Is  il  worth  sKIO.doo  lo  the  cjly  to  take  thi'  neeessary  ste|)s  to  hrinu  al)out 
this  eliaiifie? 

(2)  Congested  Block  Data: 

.\rfji  of  hunt  occupied  hy  imitdin^s 6'2,0()0  s(j.  ft. 

Dt'iLsity  of  populaliim  per  iicrc lill 

N'unilicr  of  lionscs I.V> 

Nurn!>cr  of  oiitl>iiitdiii^.s Hid 

XuniluT  4if  st(ir('-s 51 

XiiiiiliiT  of  rear  liouscs 65 

Xuiuljcr  of  lioiLscs  in  l)ad  repair 63 

Xmnher  of  woixien  houses 18 

Xumlier  of  privy  vaults 18 

Xuniljer  of  privy  houses  al)ove  vaults il 

Xuniber  of  liydrauts 81 

Xumtjer  of  people  using  tliese  liydrants  1i\ 

Death  rate  per  1000  people  for  the  ward  of  wliicli  this  Ijlock  is  a  part  .  .  \^.'M 

What  Chance  Have  the  Babies   in  such  an  Environ.ment? 

(3)  Reconstructed  Block  Data: 

.\rea  of  land  occupied  liy  Iiuitdings 4!),000  sq.  ft. 

Density  of  jjopidation  per  acre ^.5.'t 

Xumber  of  houses 04 

\uml5er  of  apartments 148 

Number  of  stores 54 

This  reconstruction  can  be  done  by  giving  the  city  power  to  condemn 
insanitary  areas,  purchase  the  property,  remove  the  buildings,  replot  the 
ground,  and  .sell  the  same  to  the  highest  bidder. 


54 


DIRECTORY  AM)  (  ATAJJUd'E  OF  KXIIIBITS 

Charts 


'J'hc  liDiisc  and  the  hody  arc  cadi  licallli  units,  and  tlic  ^tnily  of  llic  lionsc 
lieallhy  sliould  lie  as  inijiortant  to  I  lie  arcliifecl  as  Personal  llytriene  is  to 
the  pliysieian.  The  Body  Healthy  is  the  Foundation  of  all  I'utilie  Health 
work. 


It    is  a  wise  coiunnnilly  wliieli   places  liraltji   al)o\"e  all  eoiiunnnity  ]ios- 
.sessions. 


Kii.i.  TiiK  Flies 
Why? 

Because — 

1.    l*'lics  hrccd  in  manure  and  other  lilt  h. 

"i.  Flies  walk  an<l  feed  on  excreta  and  sputa  from  people  ill  with  typhoid 
fever,  tuherculosis.  diarrh(eal  affections,  and  many  other  diseases. 

;>.   ( )ne  fly  can  cari'y  and  may  dci)o-it  in  our  fi)o<l  (i. ()()((. 000  l)act(>ria. 

4.  A  fly  is  an  enemy  to  health  the  health  of  our  childi'cn.  and  the  health 
of  our  comunniity  I 

A  lly  camiot  d<'\clop  fi-om  the  c^l;  in  less  than  S  days;  therefore,  if  we 
clean  iii)  everythini;  thorouiihly  every  week,  and  keep  all  uiamu-e  screened, 
there  need  Ix'  no  flies. 


Waste  Disi)osal. 
.V  clean  eitv  is  a  healthv  citv. 


The  city  makes  no  original   sanitary  inspection.      Hence  the   following 
nuisances  are  only  corrected  when  a  citizen  files  a  complaint. 

I'liutuKraplis 

Insanitary  conditions. 

One  of  many  insanitary  vacant  lots. 


Two-family  house. 

One  has  five  children  and  the  jiarents  sleepini;  in  one  room. 

Privy  vault  adjoining,  full  and  leaking. 


Waste  Disposal. 

A  dean  city  is  a  heaHhy  citjr. 


Two- Family  Roij» 

tS  dllMmt  ami  Uviuiwtf  iW;u^  ineor  mm. 
Phyy  vsoll  »f>mij  Ml  ini  Walai^. 


Plate  XVI 

PHOTOGRAPHS  AXD  CHARTS. 


HOUSING  COMMISSION  OF  PHILADELPHIA 
56 


niRKCTOUY  AM)  <  ATAIJU.l'K  OF  EMU  HITS 

Sidowulk  made  filthy  by  flow  i'rom  alley. 

(iarl)aiie   and   waste   washed   down,   tlestroyiiit;   ])a\(Miien(    and    Mockini; 

gutters. 

Dwellini;      Teii.-inl   rclii^cs  to  iiiov'e;    no  lied;    windows  hlockcd  liy  ])a|:er. 

House  di-;iin  iii|ie  carrNiii;;  water-closet  liltii.      Defective  test  caj).     Over- 
flow  to  I  lie  cellar-kitchen  lloor. 

Dol;   uiauurc      collecle<l   in   I  he  couulrx    and   >tort(l   in   the  eil\'.      II    >uch 
houses  in  one  ci)ni;cs|c(l  Klock. 

Cellar  conJainint:  •'  lee!  of  water.      -.">  lion-~e^  in  one  row  with  w  ater  in  t  hi' 
cellars.      llun<lrc(U  of  sudi  in  the  cit\'. 

Cellar  licd-rooni.      Size  .")  teel  S  inches  wide.   1  \  feet    loni;,  (i  fei't  (>   inches 
hi-ili.     \\  indow    '  ■>  foot  si.\.     .'}  men  sleep  here. 

Sumniei' conditions.      ()id\'  one   row  of  houses  underdrained.      Flies  and 
liios(|uitoes.     SnielU  unhearahle.     Tenants  keep  their  windows  closed. 

.\lley   in    new   areas.     <)   parl\'    pri\  ies.    7    full.    .'!   overflow  ini;-.      Decayecl 
\'(>iielai)les. 

Household  waste  ciu|)licd  into  the  street. 

.\llev  fille(|  with  ii-<-;    coiitainiut;'  refuse  and  iiarhage. 

Cellar  Dwellinj;   -  Liviui;'  room.      No   law   to  prohiliit    its   u^c.      In    many 
.such  rooms  families  eat,  live,  cook,  and  sleep. 

Cellar  Dwelling; — Rear  room.     Xo  frc^h  air;    noliuht:    no  window. 

Street  made  filthy  hy  surface  drainage. 

Old  section  of  the  city.      Household  wa-te  in  tilltfers. 

Dead  End  .Vlley. 

With  a  one-room  occu])ietl  house  al)o\e  .'?  defective  hopper  closets. 

Narrow  street   entrance — surface  drainaye — S  families,   many   hoarders, 
small  overcrowded  rooni.s. 

Dead  End  Street. 

Horizontal  tenements:   surface  drainat;e;    insanitary  surroundings. 

Dead  End  .Vlley. 

■5  houses — two  unsafe.     Privy  lieneath  house. 

i  compartments,  vault  io  feet  dee]). 


use*-:  :<,:eii..*^i'.'^ 

i!  1.  Flies  breed  in  manure 
^;  Z  Flies  walk  and  feed  on  t 
jwn  people  iH  with  l|/phoid  fever  tv_  _ 

^^^al  affedions,  and  many  other  du« 
3.  One  flv  can  carry  and  may  deposit 

i-— «v»  bacteria. 

■  is  an  enemy  to  heattli.-tlie ' 
I  bealtti  of  our  coramunify! : 


fly  cannot  develop  mm  the  egg 
^—^  lefcre.  if  we  dean  up  every. 
sk.  and  keep  all  manure  scree 
be  no  flies.  — ' 


si 


Pl..\TE    X\II 

PHDTIIGR.APHS  .A.\D  CH.^RTS.     HOUSING  COMMISSION  OF  PHIL.ADELPHI.A 

58 


DIRKCTOUY  AM)  (    WIW UHiFf-:  OF  FXIfflirTS  59 

Eiiclosod  Rear  <  'omt. 

8  houses  with  4  cellars  lull  of  water. 

Block  Chasm. 

These  shc(l.s  lilock   IIh-  kilchcii   windows. 

J'cn  rear  lioiiscs,  n.irrow  alley. 

Surface   (Iraiuat^c    KiO    feel,    1    lixdi-.inl .    I    pri\y,    71)   pcopli-   and    many 

hoarders. 

Civic  T  s;liness. 

!)  narrow  alleys  rnn  in  from  lhi>  street  to  .t'>  houses. 

Two  and  one-half  acres  of  roofs. 

With  an  occasional  chasm.      T nany  linildiiii;s  on  the  land;    no  Mock 

N'cntilal  ion. 

One  reason  for  i).(l(IO  prcv cntaMc  deallis  ammallx    occnrrini;  in   i'liiladi'l- 

phia. 

•K). 0(1(1  propciiics  not   nmlcrdraincd.      iinriilicd>  of  city  sli-ecl-.  one  Mock 

lonji,  solidly  Imilt  up,  wit  hunt  -(■wcrs. 

I'i-  I'cns. 

In  a  pop  I  dons  area  and  near  a  pnMic  school  in  Soiit  h  W  est   I 'hi  la. 

Filthy  I'ifjficries. 

Near  two-story  homes  in  IJiclimond. 

Scraping  the  jiiii  manure  out  upon  the  ground  in  the  Slamijcrs  Lane 
distri<-t. 

Stackint;'  piu  filth  in  li.ick  >ards. 

Hrecdinu  flies.      South  side  of  Stampers  Lane. 

Back  yards.     .Vsh  and  refuse  pile. 
The  \-ault  is  one  of  --ij, ()()()  in  the  city. 

LTjicovered  uarbage  wayon  near  puhlic  school. 

Few  such  wagons  are  water-tight,  therefore  they  go  ahout   leaking  >will 

along  the  city  streets. 

Diagnim. 

This  diagram  indicated  the  method  ])ursued  hy  the  Philadel])hia  Housing 
Commission  in  carrying  out  its  investigations  regarding  conditions  of 
drainage. 


CO 


DiRFJ  ninr  axd  (  .itakk.i'f.  or  KXffnurs  ei 


The  Visitinff  Nurse  Societif,  Philadelphia 

Suction  A.      H..i.lh  \n.  S.      [Sr,-  riiirs  \..~,  Will,  XIX,  X.\,  ;iri,l  XMl 

This  hontli  coulaiiicd  clKirK  and  pli()l()j;Tai)lis  wliicli  illustrated  the  aiiiis  and 
work  of  llic  Society.  Tiie  two  rooms  in  adjoininii'  hootlis  illustrated  wliat  the 
Society  acconi])lislicd  in  ojie  instance  in  couveiiinj;  a  dirty,  insanitary  room  and 
alley  into  une  that  was  clean  and  sanitary. 

The  object  of  this  Society  is  to  give  to  the  poor  and  to  those  of  moderate 
means  the  best  home  inn-siiif;  jjossihle  under  the  circnnistances. 

f'liart.s 


Concentrate  on  the  mother.  What  the  mothcT  is  the  children  are.  'I'he 
stream  is  no  ])urer  than  the  som-cc. 

Let  us  glorify  motherhood  hy  every  means  in  our  jiower  ....  Let  us 
have  good  mothering;  that  is  at  the  foundation  of  happy,  lu'althy children. 
— John  liiinis. 


\  woman  rarely  looks  better — even  the  plainest  woman-   than  when  she 
has  a  little  child  clinging  to  her — her  Ijest  ornament. 


The  ups  and  downs  of    health  closely  follow  the  ups  and  downs  of  the 
windows. 


Hygiene  is  the  Science  of  Health,  and  to  have  healthy  people  we  must 
begin  with  the  T5al>v. 


Plate  XIX 

PHOTOGRAPHS  AXD  CHARTS,  X'ISITIXG  NT'RSE  SOCIETY  OF  PHILADELPHIA 

02 


DIRECTORY  ASP  (  ATM.nc.l'E  OF  KXIIIIilTS  63 


CaRK  of  THK  Im'ANT  in  TIIK  IIoMF. 

Love  and  affection.     15c  spariiif^'  iif  kissc-..      I5ut  ticiitly  cudcllc  the  l)al)y. 
Do  not  starve  the  bahy'.s  heart. 


Conditions  II ahmi  i  i.   lo   Hauieos 

1.  15a(l  lioii-iim'. 

'2.  (^iie-.!  i(iiial>le  iiuhlstrial  nietliiHl-.. 

.'!.  IiiHoraiit    or   iiichtt'ercnl    niollierhood. 

\.  Irre.s|)onsil)le  I'at  herliood. 

.5.  Disrefjard  of  tlu'  essentials  of  personal  or  l)al)\'  hygiene. 

(i.  Tnii)erfeet  or  inadt'cpiate  su]ier\  ision  of  the  milk  snpply. 

T.  Kilher  inadeipiale  sanitary  laws  or  a  failure  lo  enforce  tliein. 


CoNDITniNS    FWOUAHI.K    TO    HaIUKS 

1. 

Intellijient  Motherh 1. 

o 

Sufhi-ient  Sleep  and  Rest. 

3. 

Maternal  Nursing. 

4. 

Daily  liathini;. 

.>. 

Cleanliness  and  Fresh  .Vir. 

(i. 

Pnre  Modified  Milk  for  Baliies  who  lia\e  to  he  artitic 

ally  fell. 

t . 

Enforcement  of  Existing  Health  and  Sanitary  Laws 

and  Police  Reg- 

nl 

ations. 

Clothing 

Soft,  easy  fitting,  and  sufiii'ient  (hut  not  hurdensome!  garments  for  the 
baby  should  be  arranged.  Tight  bands  are  undesirable;  but  a  smooth 
knit  undershirt  mav  be  needed  in  cold  weather  or  for  delicate  infants. 


Plate  XX 

PHOTOGRAPHS  AND  CHARTS,  VISITING  NURSE  SOCIETY  OF  PHILADELPHIA 

64 


DIRKCTORY  AM)  (  ATMJX.l'E  OF  I.XIHIUTS  65 


15  \  ihim: 

Once  or  twice  a  (lay  a  niodcralcly  warm  liatli  slioiild  he  ])r(i\i(ic<l  lor  t ho 
l)al)y,  with  identic  aiui  carcl'iil  cloaiisiiii;  of  all  jiarls — eyes.  cars,  and  cvcry- 
wiicrc.  Kcc])  lh<'  l)a!)y  clean  ami  sweel,  and  "chanucil"  as  ot'lcii  as  lu'cd 
arises. 


Twenty-two  lionrs  of  sleep  ont  of  each  twenly-fonr  is  I  he  rnle  for  the 
first  month,  with  abundant  rest  and  freedom  from  exeitemenl  all  through 
infancy. 

A  wakeful  and  pcexisli  child  is  a  sick  child. 


FnKSH    All! 

The  hahy's  room  should  lie  llie  hest  xcutilalcd  in  the  lionsc.  and  kept  free 
from  dust,  smoke,  fumes,  and  i,'ases.  Bahy's  outiniis  should  he  anijilc.  with 
avoidance  of  sudden  chauL'cs  and  glaring  sunshine  in  its  eyes. 


Flies  are  the  danger  signals  of  the  presence  of  filth 


Fingers 


Filth '('^,l-Vv,T 


PlIOTOGRAl'lIS    KkLATINC    TO    BoTTLf>FED    BaBIES 

Bottle-fed  l)al)ies.  Visiting  nurse  instructing  mother  as  to  the  dangers 
of  the  ])acifiers  and  the  had  efi'ects  which  result  from  unclean  methods  of 
prei)aring  food  for  the  babies. 

A  Bottle-fed  Baby. 

Bottle-fed  Baby. 

Numerous  patent  foods  tried  and  failed. 


z 

o 

H 
U 
D 
0! 


z 


u 
w 

c« 
W 

H 

O 

w 
J 

H 
H 


06 


niniJ  TORY  AM)  (  ATM.lU.l'K  OF  KMIIIilTS  67 

Same  I5aliy     six  moiilli--  Iat(>r     al'Icr  iiiatcnial   tVcdiiii;  liail  l)c<-ii  socurod. 

Twins—  I?iil  tic-lcd.  IJotli  liail  Niiiiiiiicr  i()in|)laiiit.  Miillicr  anxious  to 
learii  iio\\    lo  Iced  the  ))ahics.      I'"olio\\('d  iii^l  ructions — l)al)ios  now    liviuu'. 

Photogkaimis  Ki  lati-nc;  to  thk  ICuif  ation  <if  I.iTxr.F,  .Motiidhs  and  tiik  IIomk 

Visits  ok  tiii;  Xiksi; 

Littlo  mot  hers  Ix'ini;  taui;Iit  liy  tlic  \'i-itiim  N  iii'sc  haw  to  care  lor  I  he  liahy. 
^lothor  at  work  duriiiLr  thi"  day. 

Group  of  anxious  little  mothers.  Matiiitii;  the  I?al)y  l,ittle  mothers 
taking  lessons  in  how  to  care  for  the  Haliy.  Oldest  i;irl  i  11  years)  kept 
home  fioui  school  to  help  her  mother  duriui;  coUNaiesceuce. 

A  mother  w  il  li  I  «  in^  \\  ho  was  eaycr  and  anxious  to  learn  all  she  could  for 
lier  hahies'  welfare. 

She  carefully  followed  the  instruction  of  the  \'isitinu-  Xursc  in  rei^ard  to 
cleanliness,  cNithiui;.  fresh  air.  slec]).  and  proper  feedinu'. 

Triplets  of  poor  .Jewish  parents  heing  cared  for  hy  a  \  isitinj;  Nurse. 

Severe  ease  of  pneumonia  found  hy  a  \'isitini;  \urse. 

The  child  lo  the  left  has  an  eczema  of  the  face. 

The  house  and  room  were  dirly,  insanilar\-.  and  Kadl.v  \<Mililaled. 

PiioTocHAPHs  Hi.i.\ri\(;  TO   K\\  ih<inmi:nt 
Surface  drainauc  from  alleyways  to  street. 

Surface  Drainaye. 

L  ncoN'cred  u'arliane  re<-eptacles. 

Court  in  Tenement.  Little  sunlinht  enters  rooms  in  rear.  Morning  out- 
ing in  tenemeni  court. 


68  REPORT  OF  THE  PHILADELPHIA  BABY  SA]'L\G  SHOW 

Section  A.     licidlli  \u.  5. 


Plate  XXII  A 


BAD  ROOM 


m;i  Tiox  A.  No.  5 


Card. 


(Actual  rcproiliiction  of  in.sanitary  conditions  found  in  a  room  opcniufi;  into  a  hiind  alley  in 
Philadelphia.) 

Dirty  Roo.m  and  Alley.  Due  to  lack  of  hoii.so-to-hou.se  sanitary  inspec- 
tion. Surface  drainage;  open  and  full  privy  vault ;  broken  brick  pavement. 
Landlord  indifferent  or  ihou<ihtlcss.  Mother  sick — family  poor,  they  do  not 
know  u-hii  the  house  and  alley  ntust  be  kept  clean,  or  how  to  improve  the 
bad  conditions. 

Time — summer.  Mother  sick,  lying  with  infant  in  bed.  Dirty  quilt 
instead  of  .sheets;  dirty  i)illow;  flies  over  everything;  unwa.shed  dishes; 
bread  and  milk  exposed  to  flies.  Emjjty  milk  bottle,  unwashed,  on  the 
table;  smoky  lam])  chinmey;  litter  under  the  stove;  unwashed  j)ans  and 
teapot  on  it.  Child  in  the  corner  with  street-cat  in  its  arms.  Dirty  wall- 
paper, window-i)anes  missing  and  holes  stuft'ed  with  hurla])  and  paper. 
No  screens  either  at  window  or  door.  Hydrant  in  alleyway  beside  open 
door;  rubliish  strewn  over  bricks;  torn  ])ictin-e  ui)ou  the  wall.  Boxes 
and  paper  and  oil-cloth  and  kindling  wood  imder  bed,  table,  and  stove. 
Door  scribbled  full  of  names,  sketches,  etc. 


DIRl'J  TORY  AM)  (  ATM.tx.li:  OF  EXIIIHITS 

Si-<li<in  A.      H..olh  No.  7. 


(I!» 


Pi.Ari-;  XXII   H 


I-MI'Kl  i\  l:l)    Ki 


.\.  Xi, 


<^'»I'<'  IldW    TIIK  15.\I)   HdoM   WVS   I.MI>K()\KD 

AMiat  was  ddiif  liy  llic  r////  -Alley  ilcamvl  and  iiiKlcrilrainccI :  |)i'i\y\ault 
cleaiU'd  and  rcmovi'd;    water  coMiiccliuns  made;  eeiiieiileil  alley\\a.\'. 

Tiy  Uw  Ldiidlonl-  ])ut  in  water,  water-closet :  repaired  and  w  hitcwaslied 
wall;  put  in  window  |)anes,  ])ainted  door  and  window-sills. 

By  the  I '/.<////((/  .V//r.s(' — Sent  for  doctor,  ex])lained  why  hou.se  and  alley 
should  be  kept  clean,  at  little  expense.     \'isited  mother  and  baby  while  ill. 

By  the  HiLsharid — Bouiiht  soap,  broom,  scrubbing-brush,  wooden  crate, 
nails,  white  i)aint.  whitewash,  two  old  brushes,  second-hand  bucket  with 
lid,  netting,  screen  door,  clock,  and  a  geranium.  Cleaned,  scrubbed, 
painted,  white-washed  room,  made  crib,  ice-box,  and  closet.  Total  co.st, 
$■2.87.     Little  mother  helped  father,  nursed  mother,  and  attended  babj-. 

Result.  Mother  in  bed;  clean  sheets  and  pillows.  Baby  in  home-made 
crib  witli  mosquito  netting  over  it.  Child  on  chair  with  doll  instead  of  cat. 
^^  alls  whitewashed.  Winilow  and  door  screened.  Window  open  from  top. 
Clean  lamp  hung  from  wall.  The  stove  polished.  Pans  ancl  s])oons  hung 
in  closet.  Clean  towel  over  table,  with  geranium  on  it.  Rocking  chair 
by  bed.  Alleyway  clean.  Covered  garbage-can.  Broom  hung  against 
door,  neat  calendar  on  wall.  Alarm  clock  on  closet  on  wall.  Alley  under- 
drained.  Alley  wall  whitewashed.  No  uneven  bricks.  Xo  flies.  Room 
is  clean. 


70 


DIRECTonV  AM)  (  ATAUXU'E  OF  I.Xlfin/TS  71 


Conditions  R elating-  to  Matrrna/  Environment 
I)u  rinff  Prcixn a n c// 

ScftioTl   A.       HiM.lll    No.    I-,'.       |S,r   I'lntr   \o.  XXIV.) 

This  ])<)()tli  coiitaincil  .1   l;iri;c  iiumlxT  of  0(liu"ilii)ii;il  cliiirt^  and  the  ^aiiilarv 
cr|iii])mi'nt  iicccs^an'  in  a  iiropcrly  lunii-hccl  (Iciivcry  roDin. 


nirlii  is  nol  llic  loiniiicMccnKMit  of  lil'i\  K\ci-y  cliild  horn  is  ali\('  for 
several  nioiitlis  l)ef()re  l)irlii:  liicrffore.  it  is  necessary  to  eonsidci  lis  weil- 
bein<'  licfore  it  is  l)orn. 


Nine  nionlii-  liefore  Kirlii  and  tlie  first  vcar  after  are  from  a  iiealtii  stand- 
point the  most  important . 

(^ver  0.0110  lialiie-  die  aimnall\'  in  I'iiiladelpliia  ihirinir  tlie  first  year  of  life. 


IlYfllKNK  (IF   I'hKCX ANCV 

Work;   Shonl.l  lie  huht. 

Heavy  hftina'  shoidd  lie  avoided. 

Slee|i  at  least  H  hours  eaeh  niijht. 

The  pregnant  woman  should  rest,  each  month,  at  the  time  she  would  expect 

the  menstrual  jjcriod  if  she  were  not  pregnant. 

('lothing':  The  elothina'  should  he  loose,  especially  aarters  and  corsets. 
Corset  if  worn  should  he  let  out  as  the  ahdomeu  increases  in  size  to  the 
extent  of  ijerfeet  comfort.     Don't  lace  tij;htly. 

Bathing-:  Cleanliness  is  essential.  Sea  bathing  during  the  early  months 
is  not  wise. 

Excretions:  Urine:  At  least  a  quart  of  urine  should  he  ])assed  in  •■24  hours. 
The  ilrinking  of  water  freely  will  tend  to  keep  the  amount  normal.  Scanty 
urine,  headache,  swelling  of  the  feet,  hands,  or  face  are  danger  signals  in 
the  pregnant  woman.  She  should  send  for  her  doctor,  adopt  a  milk  diet, 
and  take  two  tahles]io<infnls  of  salts. 


72    REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 

No  child  can  be  born  in  good  liealth  if  tlie  parents  suffer  from: 

1.  Lack  of  food.  -t.  Worry. 

2.  Overwork.  5.  Excitement. 

3.  Fatigue.  6.  Poverty. 


Thp:  Effect  of  .\lcohol  ox  Infant  Mortality 

The  alcohol  habit  increases  the  infant  death  rate  l)y  weakening  the  minds 
and  bodies  of  adults,  thus  making  parents  less  ca])alile  of  bearing  healthy 
children  and  of  caring  for  those  that  have  been  born. 


Bad  Habits  in  the  Parents  Which  Affect  the  Life  and  Health  of  Infants 

Use  of  alcoholic  drinks,  morphine,  opium,  cocaine.     Tea  or  coffee,  used 
in  excess  bj^  the  expectant  or  nursing  mother  is  poisonous  to  her  child. 


Poor  health  of  the  mollier  and  conse<|Ucnt  want  of  breast  milk  are  the 
main  causes  of  infantile  mortality;  therefore,  it  is  of  the  greatest  importance 
that  the  mother  guard  her  health  before  the  baby  is  born. 


^Menstrual  cliart  showing  the  relationshi]>  of  menstruation  to  jjregnancy. 

Miscarriage,  Prem.\ture  and  Still-births 

Frequency 

There  were  30,07.)  babies  liorn  in  Philadelphia  last  vear. 
"      2.131  still-births. 

o.)0  |)remature  births  in  which  the  l)aby  dietl. 
ai)proximately  10, GOO  miscarriages. 

In  Philadelphia  a  baby  is  born  alive  every  thirteen  minutes,  and  a  baby  is 
lost  liefore  birth  every  forty-one  minutes. 

C.-VUSES 

Accidents:  Any  violence  causing  a  displacement  of  the  womb  or  lireak- 
ing  loose  the  delicate  attachments  between  the  baby  and  mother. 

Diseases  of  the  Mother:  Inflammation  of  the  womb,  tubes,  or  ovaries; 
Syphilis,  Gonorrhea,  Bright's  Disease,  Tuberculosis,  and  Ty])hoid  Fever. 
Syphilis  is  the  cause  of  42  per  cent  of  the  miscarriages  in  the  latter  month.s 
of  pregnancy.  No  healthy  baby  can  be  born  to  .syphilitic  i^arents.  It  will 
die  either  before  birth,  or  soon  after,  or  grow  to  be  an  invalid,  or  become 
an  innocent  offender  to  society. 

Any  condition  or  disease  that  causes  death  of  the  child  tends  to  cause  a 
miscarriage.     Syphilis  is  again  the  most  common. 


nilU'JTORY  AM)  I  A'lWlJX.l'K  OF  IXIltltlTS  73 

PRf;Vp:NTI()N  OF  MislAliUIAGKS 

Don't  (Id  llio  family  wash  during  |)re<;iianfy.  Il  i-  clifapcr  lo  jiay  for  the 
wash  than  to  he  siek  in  hed  for  a  week,  (io  to  lied  at  onee  if  there  is  nnieh 
liaekaehe  or  pain  in  the  alxloinen.  If  hleedinj;  is  present,  consult  your 
])hysieian.  Any  <mc  of  these  syniptoins  may  mean  that  a  miscarriage  is 
threateneil. 

KkI'I'.i    r    (IF     M  ISC  AHHI  \(;KS     VMI    AllllH  IKIN     (IN     Im    \\r     MllUTM.FI'^ 

Of  111  iiifantv  (lead  from  innnat  uril.v.  S!l  molhers  SO  per  cent  i  had  a 
history  of  miscarriages,  alioilion  or  |irematnre  liirth.  lre(|Mcnll>"  due  to 
.syj)hilis. 


IXDlCF.n  ATiOHTKIN" 
Moi-all\   it  i-  \\  roiig. 
J'hy.sicall.v  it  i^  wrong. 

Why  doit  ' 

Don't  ask  yoni'  doctor  to  perform  an  aliorl  ion. 

Don't  altem|it  it  yonrsclf. 

It  is  a  crime  e(_inal  to  the  nnwder  of  your  lialix'  afler  its  liirl  h. 


(irai)Iiic  f'liarl. 

Showing  Canses  of  Hlindness  in  their  i'roporlioiiate  rre([iiency. 
Indicated  liy  parallel  line-~  of  ditferent  length-. 


74 


DIRFJ  TOI!)'  AM)  (  ATM.iX.rE  IH'  /.XfUlilTS 


Care  of  the  Art*:'  /ior?i 

Section  A.      H,H,lh  No.  1(1.      |S,-.-  Plate  XXV. 1 

'llii^  Koiilli  ((iiihiiiK'il  ,-i   iniinlHT  ot  (•(liicatioiial  cliaii-  and  plinlduraplis,  and 
sonic  <il  I  lu'  CI  I  ui|  mil -11 1  necessary  In  tlic  care  nt'  I  lie  hali.w 

Cli.irls 


TlTK   ("iOLI)E\    Rn.K 

For  Tin;  1,111.  AM)  ]Ii;\i.Tii  of  tiii;  H.vby 
"Feed  with  llic  Mollicr"--  Milk. 
'I'lic  Mullicr's  Milk  i-  llic  Naliiral  Foixl. 
AM)    Tin;    HK.ST." 

aviiy:^ 

Out  of  101)  liiillle-lcd  cliildren  ."«(!  die  diiriiii;  llicir  lirsl  year. 
Oiil  III'  10(1  lircasl-lcd  cliildren  mily  '  die. 

FyVcn  llic  l)i)llle-led  lialiies  whn  >iir\i\e  arc  mil   -ii  ^Iriiiii;  and  licallli.N'  as 

l)reast-fed  lialiics. 

Hot  tie- ted  lialiies  "catch  ""  diseases  mure  lilt  en  Ilia  n  I  he  lireasl-reil. 

'lliere  arc  \i'ry  few    nintlu-is  ulin  caiinnl    inir-c  lln-ir  lialne-,.      |)i)  nut   lie 
di.scoiira.ucd;    ])iil   the  liali\'  In  llic   hrcast  soon  al'ler  liiiili;    cdiilinuc  this 
at  intcrv.ils  until  the  milk  comes. 
It  will  rarely  fail. 

The  milk  cannot  lie  liikmI  if  the  inothci  docs  not  i^ct  omid  1 1  and  plciitv 

of  it. 

F\)od  for  the  nur.sing  niotlicr  should  consist  of  milk,  urucl,  cocoa  and 
milk-toast  for  the  fir.st  three  da,\s.  'riieii  the  \-ariety  and  amount  .should 
be  gradually  increased. 

Take  plenty  of  \ci;ct allies:    liread  and  liiitler  and  milk. 

Milk  is  the  liest  food  for  nnr-inu'  mothers. 

Meat  once  a  day  is  usually  eiioiiiih. 

Avoid  hii^hly  scasoni.'d  foods,  sahuls,  jiastry,  strawherrio.s  and  tomatoe.s, 
alcoliolic  drinks. 

Weak  tea  ami  coffee  mav  lie  taken  oiici'  a  dav. 


76         REPORT  OF  THE  PHILADELPHIA  BABY  SAi'IXG  SHOW 

First  Aid  for  the  Baby  Born  Before  the  Doctor  Arrives 

Resuscitation  of  the  Baby. 

The  lialiy  .should  lireathe  at  once  after  birth.  If  there  i.s  no  movement  of 
the  c-he.st  or  if  the  face  and  Hjis  become  darker  in  color,  it  is  a  .sign  that  air 
is  not  entering  the  lungs.  One  way  to  make  the  baby  breathe  is  quickly 
to  cleanse  its  mouth  and  throat  by  means  of  a  little  cotton  and  your  finger. 

Tying  the  Cord. 

Tie  the  cord  immediately  after  the  birth  of  the  liaby.     Tie  it  tightly  about 

two  inches  from  the  baby's  abdomen  with  linen  tape  which  has  been 

boiled.     Cut  the  cord  J^  inch  above  this  with  .scissors  that  have  been 

boiled. 


Wr.\p  the  Baby  in  a  Warm  Blanket  Immediately  after  Birth 

With  a  medicine-dropper  put  one  drop  of  a  1  per  cent,  solution  of  silver 
nitrate  in  each  eye.  Flush  out  at  once  with  l)oric  acid  solution  or  weak 
salt  solution. 

Gently  rub  the  baby  with  warm  olive  oil. 

Wii)C  off  the  excess  oil  with  clean  soft  linen. 

Bathe  the  baby  at  the  end  of  an  hour  with  warm  water,  Castile  soap,  and 

a  soft  cloth. 

Bathe  the  hatiy  in  a  warm  room  on  the  lap.  not  in  a  basin. 

Dust  tiie  cord  thoroughly  with  l)oric  acid  jjowder  and  fold  it  between  two 
pieces  of  sterilized  gauze. 

Wrap  a  flannel  binder  five  inches  wide  around  the  bal)y"s  abdomen. 

This  binder  keeps  the  cord  dressing  in  ])lace  and  the  baby's  abdomen 

warm . 

Change  the  liinder  every  day. 

One-third  of  the  Deaths  of  Children  Occur  in  the  First  ]Month 

Care,  cleanliness,  proper  breast  feeding  and  attention  to  what  your 
Doctor  (not  your  neighbor)  says,  will  prevent  this  mortality. 

Shield  the  Baby's  Eyes  fro.m  Strong  Lights 

The  baby  should  be  kei^t  in  a  dark  corner  of  the  room  for  the  first  week 
or  two;  its  eyes  may  be  permanently  injured  by  exposure  to  strong  light. 
Wash  the  eyes  for  the  first  week  with  boric  acid  solution. 

Do  Not  Pick  the  Baby  Up  When  It  Cries 
The  baby  should  be  disturbed  for  only  three  rea.sons: 

1.  To  feed  it. 

2.  To  batlie  it. 

3.  To  change  its  diapers. 


DIRECTOllY  AM)  (  ATM.iK.li:  (IF  rXII/IUTS 
Prevent  CoNsrn' aihin   in  the  IJahv 

'I'lic  h.-iln's  howt'ls  slioilld  lir  lilip\t'(l  once  or  Iwicc  ciicll  <l;iy. 

If  iioivssary,  give  a  rectal  iiijeition  of  two  ounces  nt  lii>ilc<l  water  under 

tlie  direction  of  a  phy.siciaii. 

XtHsiNc  Tin;   I?  \HV 

The  motlier  should  he  on  Ikm-  side.  I  lie  cliiid  siiould  re>l  on  the  lied  and 
the  mother's  arm. 

Fkedim;  Tin;  Mvnv 

The  l?al)y  should  not  lie  gixen  food  for  the  first  t\vei\c  horn  s  after  liirlh — 
If  very  fretful  ui\e  a  little  warm  water  that  has  heen  hoiled. 

I'dr  the  fir-l  two  weeks  mirse  tiie  iialiy  at  thi'  mother's  lirea--t  e\-ery  two 
jiour'-  for  fifteen  minute-  at  a  time  durinu  I  lie  da\'  and  t  u  ic<'  at  niiilil . 

Si.EEI'IMi   .\(  <  ()\I\l(ll) ATI<i\s   I  (IK  TMi;   h\nv 

The  Ualiy  slioulil  not  -lcc|i  in  the  same  Keel  uilli  the  mother. 

This  is  dangerou--  as  many  lialiie--  have  lieeii  smothered  or  made  sick   ill 

this  way. 

.V  liurean  drawer  oi-  clotheshasket  makes  an  exccllcnl  lied  for  tlie  lialiy.  if 
a  reiiiilar  crili  i-  not  to  he  had. 

If  tile  Haliy  is  l'oorl\'  Nonri-hed  or  Premature: 

Do  not  dress  the  haliy  in  tiiilit  clolhiiiii  hut  wrap  it  in  warm  hiaiikets 
and  siirroiinil  it  with  strong  hollies  filled  with  hot   water,  lightly  corked, 

an<l  do  not   hat  lie  the  liali\'. 

Dre.s.s  the  Haliy  in  Loose  Clothing. 
(See  K.xhiiiit  of  Clothing.) 

If  the  Mother's  Uri'asts  Hecome  Inflamed.  Hard,  or  Caked  ; 

Make  a|i|ilications  of  hot  water  and  apply  a  hinder  to  support  the  hreasts. 
Do  not  ruh  or  hruise  the  hreasts.     Consult  your  Doctor  Prompt l\'. 

Cracked  ni]i]iles  may  lead  to  an  ali--ce-.s  in  the  hreast,  therefore,  cleanse 
the  ni[)ples  w  itli  a  lioric  acid  solution  hefore  and  afternursing.  I'se  a  nip))le 
shield  when  the  niiijiles  are  (Tacked  or  sore. 

If  THE  Bakv  has  a  Fever  or  .\  Con.n  Consilt  a  Do(  tok  \t  Once 

I'fl(itui;ni|ills 

Proper  position  for  the  liahy  while  lieing  dressed  and  changed. 

Bathe  one  part  of  the  liody  at  a  tiiiii'.  Keej)  the  parts  not  l)eing  hathetl 
well  co\ereil. 


78         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Dressing  the  Baby. 

Notice  how  loose  the  clothing  of  the  baby  is. 

A  Cheap  Crib. 

Baby  Ward  in  a  ^Maternity  Ilosjjital. 

Walls,  floor  and  i'urniture  can  lie  easily  disinfected.     No  crevices  for  dirt  or 

^ernis. 

Afodel  Bath-tubs  used  in  a  ^Maternity  Hos])ital. 

One  tub  in  use  while  the  other  is  being  steamed.     After  every  bath  these 

tubs  are  freed  from  germs  by  means  of  steam. 

Baby  Ward  in  a  Maternity  Hospital. 
Abundance  of  sunlight  and  fresh  air. 


Committee  for  Prevention. — A^.  V.  Associatioti  for  the 

Blind 

Section  .\.     Booth  Xo.  H. 

This  booth  contained  seven  charts  bearing  upon  the  causes  and  prevention 
of  blindness. 

Chart  1.     [See  Phitc  Xo.  XXVI.l 


"Mit  Messer,  (label.  Feuer,  Licht, 

Spielen  kleine  Kinder  nicht." 

"Lest  they  rue  a  sightless  day, 

With  knives  and  fires 

They  must  not  l)lay.'" 

— German  Folk  Rhyme. 

Articles 

The  playthings  which  have  blinded  many  eyes 

Scissors 

Knives                           Buttonhooks               Popguns 

Pencils 

Pens                               Sharp  sticks                Hatpins 

Forks 

Hairpins                        Matches                       Washing  soda 

Pepi)er 

Stones                            Putty-blowers             Tinswords 

Bean-shooters             Umbrellas 

Why  let  the  children  jilay  with  such  dangerous  toys? 

luiu.i  ToiiY  AM)  (  ir.u.ix.ri:  of  exiiiiuts  td 

Cliart    i.      [See  Pliitc  No.  \\\  1.] 


Prc\('iiti()ii  of  Uliiidin'ss 

'l"rM(li<iiii;i 
(ir;iliul;it<'(l  l\vi'liils 

lMi..f,,!;n.,ili  ,.f  Cirl 

Blind  I'l'diii  'l'r;iili(iiiia 
Ivirly  treatment  woiilil  lime  sinccl  lier  siirlil 

Graiuilaled  eyelids  sometimes  eail-'i'  l>lilidiiess  iiiiles-,  treated  pniiiipt  iy. 
TraeliDina  is  very  eoiitaiiioiis. 

1  siiiy  ediiimnii  towels  one  souree  of  ronlau'ion. 
I{iiliiiinu  eyes  with  dirty  hands  another  souree. 
Cleanliness  and  fresh  air  the  hesl  |(re\enti\-es. 

Dont  delay  iroini;  to  a  doctor. 

Any  diseharf^e  from  the  eye  should  Ix'  inxcstiu'aled :    it  may  saxc  you  vears 
of  blindness  or  seriously  \veak<'ne<l  siuht. 


CIkiiI  Xc.  3. 


J're\'ent  ion  of  Ulindness 

|{al)>  -  Sore  l'",yes 
(( )|ilil  lialmia  Neonatorum) 


Directions  for  the  use  of  I'rex'cn- 
tive  SolutioTi 


Ptiiitdfirnpti  i.f  l.illlc-  f.lri 


Bottle 
Dropiior 


Victim  of  "Bahies"    Sore  Eyes" 
AKout  '25  |)er  cent,  of  all  blindness  is  due  to  "babies"  sore  eyes  " 

Dangerous. 
Due  to  a  germ. 
Preventable 


This  disease  is    - 


If  taken  in  time  Curable. 

One  drop  of  1  ]>er  cent.  Nitrate  of  Silver  Solution  woidd  have  saved  their 
sight. 

Two  cents  and  two  minutes  of  time  may  save  70  years  of  darkness. 

In  New  York  State  any  physician  or  midwife  can  olitaiu  this  solution  free 
of  charge,  from  the  local  Board  of  Health. 

If  Baby's  eyes  are  red  and  swollen — see  the  eye  doctor  at  once. 


PREVENTION 
OF  BLINDNESS 


Spulcn  UrnnlViid.  1-    ,,,,1,1 
W  illi  kiuM  s  ami    I  iri  ,- 


\ 


he    pi33^t\in^^; 
which  have  hhndcOTnaa>'  eyes 

;>i  i.^-oi  ■-  l\ni\cs  InjIliinliiHiks  p(ip^\^uii,s 

pnu  lU  i>cns  sli.irpsl.il  L  h.ilpms 

t'ui  I-,-  hairpins  m^Uii'  s  v.,ii.hm^:.\«].i 

p.  IT"-  --l™--^  |,,II.H..»„.  l,u,.«o,xl. 

Why  lei  Ihc  children  plav 
wilh  such  dangerous  tovs" 


(t: 


PREVENTION 
OF  BLINDNESS 


Irachoma 

Gramilalcd    Fac-IicIs. 


Bhnd   Itom  Trachoma 

i",ii/ii  lrai///uvi/  nva/(/ /nii'i- fui'tif /ur.-:hi/i/ 

bluitf/uss  unless  /rcu/a/ pf\yf//^-<//(/ 

Trachoma  is  vcr\  conlaj;iou.s 

?/s///i/  corumpn  lonr/s  tvti  st'u/i  i  ■ ,  ■/<  t  v/A/tui  w 
Rti/'d/uii  aics  ivi/Zi  ifi/lji  /it///ifsi///t'//jtv  S(^i/ni' 
C/t (//i/i/icss ,j//,/f/i s/i i///  /A' A >//'//  / 1  /,/, I i :s 

Donl  dcla\'  ^oin^  lo  a  liotlor 

.Uini  Jisi/h//i/<-  T'O"/ //u  a/cs  s/ic>ii/(/ ir 
i/nrs/iiiu/itiu/ //uu/  sart' iuyi  i/cu/s  o/ 
M/nf//iss  IV  saio//s/t/  tir<iAt/;i;/  .-ui/// 


Ctv/J//ti//ct-  /.V  />.  rt-////tv/ 


Plaie  X.WI  Charts  from  Section  A,  No.  ii 

COMMITTEE  FOR  PREVENTION.  N.  Y.  ASSOCIATION  FOR  THE  BLIND 


80 


DIRECTOUY  AM)  (  ATM.oarK  OF  EXIIIIUTS  81 

rliart  4. 


Pkkvi:nti()\  of  Mlixdxk-^s 

About  :'..). (IIIO  pcii|)lc  iKH'dlcssly  hliiid  in  llu-  rnilcd  States. 

l'lii.l..^nL|ih 

A  i^riiiip  (if  cliildrcn  wliosc 

sifillt  was  needlessly  lost. 

'J'lie  causes  of  needl<'ss  lilindiiess: 

( )|)lillialniia  iieoiiatonuii. 

'J'raeli,)nia. 

'riil)ereulosis  of  eves. 

Iiiflaiiiniations. 

IndnsI  rial  accidents. 

A\  ood  alcoliol. 

Fourth  of  .lulv. 

Nejilect  of  minor  injuries. 

Constant  strain. 

70, 000  eyes  wasted  for  want  of  lare. 

Chart  7. 


Prevention  of  IJlindnes.s 
Legislation  Needetl: 

A  law — to  compel  physicians  and  niidwives  to  re|)ort  all  cases  of  re<l  and 
.swollen  eyes  in  the  new-born  to  the  local  boards  of  health  within  \i  hours 
after  discovery. 

A  law — re(|niriui;  local  healtli  officers  to  see  that  all  cases  of  ophthalmia 
neonatorum  receive  adequate  treatment. 

A  law — comi)elling  physicians  to  .see  that  ca.ses  of  contagiou.s  disease.s  are 
surrounded  with  pro|)hylactic  safeguards  against  communication. 

A  law — reciuiring  ade(iuate  training  of  mitlwives  and  systematic  registra- 
tion aiul  control. 

A  law — compelling  manufacturers  to  install  api)liances  to  prevent  injuries 
to  eyes. 

A  law — prohibiting  indiscriminate  use  of  fireworks. 

A  law — requiring  the  proper  lighting  of  all  public  buildings,  jiarticularly 
factories  and  schools. 

A  law — preventing  the  manufacture  of  wood  alcohol. 

A  program  which  every  good  citizen  will  work  to  enact. 


REPORT  OF  THE  PHILADELPHIA  BABY  SAIIXG  SHOW 

Chart  5. 


Prevention  of  Blindness 
70,000  Eyes  Needlessly  Lost 

(irnpliic  ( 'hart. 

Neglect  and  Abuse,  21,000  '  Industrial  Accidents,  12,000 

Fourth  of  July.  (iOO 
Oplitlialmia   of   the   New- 
born, 3.5,000 

A  little  care  at  birth  would  have  saved  about  .So, 000  eyes. 

Immediate  treatment  and  projier  care  would  have  ;aved  about  21,000  eyes. 
Industrial  precautions  would  have  saved  about  12,000  eyes. 
A  sane  Fourth  of  .luly  would  have  saved  over  (iOO  eyes. 

70,000  eyes  sacrificed  through  carelessness  and  ignorance. 
Cost  in  money  to  Society,  about  $12,000,000  every  vear. 


Chart  6. 

Prevention  of  Blindness 

The  Fatal  Towel 

(Towel  on  roller) 

The  common  carrier  of  eye  disease. 

It  lurks  in  ofBce,  factory,  hotel,  store,  and  school. 

spreading  disease  from 

eye  to  eye. 

Xerer  Use  il 

Section  C.      Booth  Xo.  "io. 

MODEL  DIET  KITCHEN 

Legends : 

Demonstration  of  Milk  Modification  every  Hour. 

Clean  Bottles. 
Clean  Cold  Milk. 
Clean  Nipples. 
Clean  LItensils. 

Meats  shoidd  be  well  cooked  but  not  overdone.     They  may  be  roasted, 
boiled,  or  stewed — never  fried. 

Cereals  should   be  thoroughly  cooked  at  least  two  hours,  or  allowed  to 
simmer  all  night. 

Demonstration  of  diet  for  second  year  of  Life  at  12  and  8  p.  ii. 

He  finir  that  all  fruit  is  fresh,  and  if  cooked,  that  it  is  thoroughlv  cooked. 


DIHFJ  TORY  . I .\7>  (  . I  T.  I  LOGl'K  OF  EXIIUil TS  83 

Department  of  Public  Health  a)id  Charities 
Bureau  of  Health,  Philadelphia 

l)l\ISI()\    OF    Ba<T?:HIOI,OGY.    LaBOHATOUV    of    Ih(.IFNK 

<  O.M  M  I  M(  ABLE  DISEASES 

|Sc,-  Plat.-  No.  XXVIIl 
Section  n.      li h  \...  K!. 

This  I til  ciintaiiH'd   the   \;ii'iiiu>  riilliirc-incili:!   used   in   lalioratorics  tor  the 

cultivatiiiii  (if  hacti'iia.  sucli  as  lidatiii.  potato,  liccf  hrotli,  and  milk.  Siiooial 
stress  was  laid  upon  llu'  rapidity'  with  wiiicii  ])ra(ticaily  ;dl  hactcria  iiiiilti|)ly  in 
milk,  till'  inhihitiiif,'  oH'cct  that  low  tcmiifraturi's  have  upon  such  t,'id\vth.  and 
the  xarious  ways  in  which  hactcria  i;ct  into  milk. 

Tliere  were  a  mimher  of  colored  j^rapliic  eliarts  ijlusf ratiiijr: 

1.  Tlie  manner  in  wiiich  tvilierenlons  cases  disseminate  tuherculosis  hy  ex- 
pectoratinji  on  the  sidewalks  and  streets,  the  s|)ufa  dryinj^  and  lieiiig  circu- 
lated throuudi  (he  atmosphere  in  the  form  of  dust;  and  the  transmission 
of  tliese  ori^anisms  tlirouuh  the  mcdiinn  of  tlies  resliM<r  upon  the  s|)utum, 
and.  later,  upon  uncooked  food  articles,  especially  milk. 

i.  The  throat  of  a  patient  with  dii)htheria;  lu-neath  this  were  a  numher  of 
milk-cans,  and  a  Icucnd  |)oinliiiii  out  how  the  milk  could  heeonie  infected 
from  such  a  patient .  i  In  demonstratinf;  this,  references  were  made  to  e|)i- 
demics  of  dipiitlicria.  tyi)hoid  fever,  scarlet  fever,  etc..  caused  through  the 
medium  of  milk  infected  liy  victims  of  mild  typc>  of  thc^e  d incases  who  were 
employed  in  the  handlinji  of  milk. ' 

.'?.  The  diphtheria  l)a<illus.  and  the  various  w.ivs  in  which  this  oruanism 
can  he  transmitted  to  a  hahy. 

4.  The  conditions  which  lead  to  the  transmission  of  the  various  contagious 
diseases  to  the  infant. 

5.  The  dangers  of  the  common  drinking-cu]). 

6.  The  various  avenues  through  which  high  temiieratures  lead  to  the  de- 
velojiment  of  enteritis  in  children. 

7.  The  various  ways  in  which  a  hahy  may  hecome  infected  witli  tuhercu- 
losis. 

There  was  a  series  of  plates  illustrating: 

1.  The  colonies  of  hacteria  which  developed  from  ^^oVtt  "t  a  teaspoonful  of 
milk. 

i.  The  dift'ereuce  in  the  uumlter  of  colonies  in  good  milk  and  in  l)ad  milk. 

3.  The  number  of  colonies  which  grew  from  water  ]ilaced  u])on  culture- 
media  (emphasizing  the  importance  of  hoiling  water  for  babies). 

4.  The  number  of  liacteria  growing  about  cows'  hairs,  placed  upon  the 
culture-media  (em])hasizing  the  danger  of  having  cows"  hairs  get  into  the 
milk  in  the  iirocess  of  milkint;). 


J 


z 


(x. 

o 


o 

H 

o 


o 
o 

o 

2 
w 

H 


O 

z 

o 


84 


DIRFATOUY  AM)  (    tT.t /.(Kill-:  OF  FMl/lllTS  85 

.).  'I'lic  iiiiinlicr  of  <ii'i;;misins  llial  urcw  iipmi  m  plalc  cNiioscd  lor  one  lioiir 
ill  an  ordinary  room  (imlicalinu  liic  (lani;<'rs  oi'  dn^l.  and  tiic  iiniiortanco 
of  protcctini;  nncookc<l  foods  from  dn-l  i. 

(1.  Tlic  mnnliiT  of  colonic^  L;ro\v  ii  from  -mcars  made  from  a  rommou 
di'inkiiii;-cnp. 

7.    Tniicrcli'  Wacilli  i;iii\\  n  fr'om  a  conunon  drinisiiiu-rup. 

S.  The  numlx'i'  of  colonics  ^  row  n  fi'oni  dirl  \'  hands  i  cm  pi  i  a  si /.in  j;  I  lie  neoes- 
sily  of  elcanlmess  of  Ihe  hands  whiUl   liandliny  mieooked  articles  of  food). 

'I'licre  was  also  a  series  of  cnll  nre  I  iilies  show  im;': 

1 .   (  olonies  of  I  he  I  nherele  hacilliis  i  llic  cause  of  I  nlicrelllosis). 

'■2.   Colonies  of  (he  pneimiococeiis  'the  cause  of  |iiicimioiiia  I. 

.'i.   (  olonies  of  I  he  diphi  heria  liacilhis  ■  I  he  cause  of  diplit  lieria). 

1-.   <  'olonies  of  lh<'  I  \  plioid  liacillus  i  Ihe  cause  of  typhoid  t'cxcr). 

.).  ('olonies  of  the  diplilhena  i;crni  t;row  n  from  milk  exposed  to  a  case  of 
dipht  heria. 

Addil  ional  cxhiliits  were: 

Two  charts  ilhistratiiiL;  the  transmission  of  diphtheria  !)>•  diplitlioria 
carriers. 

.V  eliart  illustrating  the  intluenec  of  antitoxins  upon  the  incidence  and 
mortality  of  diphtheria  in  the  city  of  I'hiladelphia,  comparing'  thi.s  with 
Ihe  incidence  anil  morlalily  of  diphtheria  licforc  antitoxin  was  employed. 
Siiecimeiis  of  antitoxin. 

Two  |)hoto<;raplis.  one  of  a  (piart  hot  tie  of  milk  coM'red  with  Hies,  and 
another  of  a  half's  feediiii;  hottle.  with  a  nipple  attached,  also  covored 
with  flies;  and  lofionds  illiistratinu  the  danger  of  such  carelessness. 
There  was  also  an  additional  and  very  ell'ective  colored  chart  contrasting 
the  methods  of  ))revention  of  disease  in  infants  with  the  conditions  which 
lead  to  the  dcNclopment  of  disease. 

Section  B.     Bck.iIi  .No.  U,     |Si-c  I'tati- Xo.  XWII  I.| 

This  booth  contained  the  following  charts  ami  photographs: 

A  large  chart  containing  much  detail  and  illustrating  the  possibilities  in 
numbers  in  house-flies.     An  exercise  for  the  imagination. 


Hou.se-flies  are  filthy 

andD; 

n 

.icrous 

to  liiiman  1 

fe 

Born 

in 

filth. 

Reared 

in  filth. 

Thev 

feed  npoii 

filth. 

and  carry 

filth  w 

tl 

then 

,  not  only  c 

•aiising 

annoy- 

ance 

.11 

niarkin 

g  a  trail  of  disease  and  < 

le: 

ith  wl 

erever  they 

go. 

Remeni 

ler — No 

Dirt. 

No  Flies ! 

8G         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


Investigations  Have  Proved  that  House 

-flies  are  bred  in — 

1. 

Ashes  mixed  with  vegetable 
waste. 

12. 
13. 

Rotten  cabbage  stumps. 
Rotten   carrots   and    cucum- 

2. 
3. 

Banana  peelings. 
Barlev  malt. 

14. 

bers. 

Rotten  feathers. 

4. 

Carrion  on  the  street. 

15. 

Rotten  meat. 

5. 

Chicken  manure. 

16. 

Rotten  potato  peelings. 

6. 

Cow  manure. 

17. 

Rotten  eggs,  paper,  and  straw. 

7. 

Horse  manure. 

18. 

Rotten  watermelons  and  can- 

8. 

Human  excrement. 

taloupes. 

9. 
10. 
11. 

Piggery  manure. 
Kitchen  sloj)  and  offal. 
Rotten  bread  and  cake. 

1!). 
20. 
21. 

Sawdust  sweepings. 

Spent  hops. 

Sweei)age  from  garbage  piles. 

In  fact,  we  may  safely  say  they  a 

■e  brec 

in  any  solid  fermenting  or  decom- 

posing  material. 

REMEMBER- 

-NO  DIRT— NO  FLIES 

The  Natural  Enemies 

of  Flies 

Toads. 
Spiders. 
Scorpions. 
Centipedes. 

Lizards. 
Some  parasites. 
Some  birds. 
Some  insects. 

Frost 
Diseases 

pecul 

iar 

to  flies. 

All  of  which  did  Init  little  to  reduce  the 

])e. 

it,  and  now 

man 

has  declared 

war ! 

Remember — N 

0  Dirt 

,  No  Flies! 

The  Common  House-fly 

The  Hou.se-fly  may 

be  a  carrier 

of  the 

following  d 

seases  to  you : 

Tyjihoid  fever. 

Cholera. 

Dysentery. 

Diarrhoea  in  Infants. 

Tuberculosis. 

Anthrax. 

Yaws. 

Ophthalmia. 

Diphtheria. 

Smallpox. 

Plague. 

Pneumonia. 

Will  yoi 

take 

my  chance.' 

If  not — then  help  tc 

exterminate 

the  house-fly. 

No  Dirt 

No 

Flies 

DIRKCTORY  AM)  (  ATM.iH.l'K  OF  I.XII/IIITS  87 


Some  Facts  (  niiccriiiiit;  tlu'  Iloiist'-fly 

Tlic  li(iiisc-fly  is  a  disease  carrier. 

'I'lio  li()iise-fl\-  (le\'el<)|is  fnnii  the  euix  to  a  t'lill-Lrrowii  fly  in  fniiii  ten  tii  four- 
teen (lays. 

A  family  of  flics  all  liorn  al  one  lime  ma>'  consist  of  l-,'()  lirolliers  ami 
.sisters.  See  a  followinii  chart  for  the  size  the  f.miily  may  assume  in  one 
season  if  the  fly  catchers  are  not  husy. 

The  housc-llv  will  lirced  in  almost  any  ferment  uil;  or  (Iccompo^inir  material 
— ])referal)ly  manure. 

Frost  kills  flies.  l>iit  etiout;h  tuck  themselves  a\\a\'  in  warm  nooks  and 
corners  to  start   tlu'  seasoiTs  crop. 


What 

to. 

oal 

KMll 

he  l'l\ 

( 

uesi  ion 

1.      .\l)olisi| 

ilies  i^row  . 

he 

lii-ecdint;   I 

Iac( 

'S. 

( See 

charl 

si 

iowhil;  I 

he 

11 

iitii. 

s  in 

u  liich 

'2.  Scre<'nin. 

mos(|uiloes 

$IO.(»(l().()()(l 

■    d 
ar( 
,-ir( 

)ors  and    w  iml 
climinaled. 
.innually  spen 

1\\  s 

t  in 

is    ;i 

arefi 
the 

necessary  exped 

1   estimator   slat 

riited  States  foi 

lei 
es 

S( 

1 

tl 

re 

ml 
at 

■Us 

1  Hi. 

t]lol'< 

^   ,ind 
than 

:>.    Traps  ,-ii 

'1  1 

<  >isons. 

4.    Kill  thai 

(l\ 

(fl 

V) 

,).    lint  liesi 

of 

dl  remoNc 

dl  t 

hin 

_s  ui 

u  liich 

fl 

<-s  floin-i 

sh 

See 

th,- 

ist. 

Renieml>er 

N 

.  Dirt,  No 

Fli. 

•si 

Some  more  facts  eoneerning  the  house-fly 

I'lie  house-fly  carries  disease  ijerms  on  its  legs,  wings,  the  surface  of  its 
body  and  in  its  alimentary  canal.  It  feeds  u])on  infected  material  and  thus 
takes  up  hjicteria  for  transmission. 

House-flies  traxel  naturally  ahout  one-fourth  mile  from  the  jjlacc  where 
thi'y  were  hied.  AVinds  will  carry  them  further.  By  clinging  to  matter 
in  transit,  they  may  he  trans])ortcd  still  greater  distances. 

The  a\erage  summer  house-fly  li\es  ahout  three  weeks.  The  last  crop 
in  the  fall  is  more  hardy,  and  enough  endure  to  start  the  next  season's  crop. 


88 


DIRECTORY  AM)  (  ATAJ.OaVK  OF  KXIfffUTS  89 

Xniiilicrs  :iii(l  ('l.-i^x-^  i>t   I5ai|cria   on  I'"lirs. 

(til  one  Hy.  C. (MM). (10(1  liaclrri;!.      Arc  ilir>  a  ntiisanco?'      'SVs. 

Tlircc  pliotofirajilis  of  liit;hl.\'  mauiiifit'il  liousc-Hics. 

Four  pliotourapli-i  sliowinu  tlic  (Icvclopmcnt  of  tlie  housc-fly. 

Tuo  plinl()i;ra|ilis  sliouiiiii  tlic  (IcNcloimii'iil  of  the  house-fly. 

Two  plinlonraph'-  -.howini:  llie  delaiK  of  llie  hoi|se-fly. 

'I'liere  was.  in  adclilion.  a  sheH'  cNleiKiiiiii  acro-s  llii^  l)o(ilh,  which  coii- 
taiiieil — 

S]  cciiiieiis  of  roaches,  l>e(ll)iii;s,  fleas  and  flies  on  plates  nn<lcr  lilass  jars. 
.\  jar  <-ontainini;  li\'e  flies  and  liedlinus. 

rictnres  of  lialiic^  fed  on  milk  conlaininL;  llie-.  and  of  Kaliic--  fed  mi  milk 
without   flies. 

Heneatli  each  was  ]dacc(l  an  c\i)laiiatory  card. 

.Ma|)  showiiifi  distriliiilion  of  manure  and  rau  jiiles  in  I'liiladclphia  under 
order  for  aliandonmcnt  hy  .lune  1st.  li)l-. 

M;ip  -howiiiti  (list  rihiition  of  slailizhlcr  lioii-cs  in  I'hiladclphi.i. 
'IIIK   I'lIILADEI.lMIlA    IKXl'llAI.   I'OK   (ONTAC-IOIS   DISKASKS 

Section  1!,      It,.,,lli  X„.  1.-,. 

'I'liis  hoolli  contained: 

.V  complete  series  of  photographs  of  the  -]i|ciididly  cipiippcd  I'liiladclphia 
II()s|)ilal  for  Contafiioiis  Diseases,  illustraliui;  the  entire  routine  of  hospital 
treatment,  from  the  iioint  of  scndint;  out  the  amhnlancc  from  the  hosjiital 
iiji  to  the  point  of  di>.ini-~'~al  of  the  patient  after  recovery. 

.V  photofiraph  of  two  infants  in  the  small-pox  ward  of  the  Hospital,  one  on 
either  knee  of  a  nurse,  one  lia\  inu  small-pox.  and  the  other,  which  had  been 
admitted  with  an  infected  mother.  havin>;-  a  recent  vaccination,  and 
illiistratini;  the  protection  of  vaccination  auainst  the  disease,  this  infant 
having  been  kept  in  the  suiall-pox  section  of  the  hosjiital  until  iK  molher 
was  remo\'ed,  cured. 

.\  number  of  iihotographs  ilhisfrating  the  eriiiitive  diseases  of  childhooil, 
as  follows:  vaccination,  measles,  Ko])lik"s  s|iots,  the  sore  throat  of  scarlet 
fe\er,  the  strawberry  tongue  of  .scarlet  fever,  chicken-pox,  nmnips,  scarlet 
fe\er. 

.V  colored  picture  of  a  tliroat  with  diphtheria  membrane  on  the  tonsils. 

A  chart  illustrating  the  great  fre(iueney  of  tuberculosis  and  scarlet  fever 
in  the  congested  districts  of  the  eit.v  of  Philadel])hia:  and  one  illustrating 
the  more  even  distribution  of  cases  of  di])litheria. 

A  chart  reading:  "Schools  become  at  times  centers  of  infection.  The 
neeessit.v  for  school  medical  insjiection  is  shown  h\  a  scarlet  fever  epidemic 
which  was  stop]:ed  l).v  finding  carrier  eases  in  schools  and  excluding  them." 


90 


DIRECTORY  AXn  (  ATAlJH.Vi:  ill'  EXIIllilTS  91 

A  chart   reading:     "Diplithcria.      A  disease   wiiicii   can   he   r<)l)l)ed   of   ils 
terror  hy   timely   and  ])r()|)er  treatment.      Formerly  \'^  per  eeul   of  eases 
died.     Now  10  ]ier  cent  of  eases  die.     Tlie  rate  eau  he  made  still  lower. 
How?      Hy  iisini;'  antitoxin  on  the  first  da.\  of  the  disease." 
(The  records  for  the  last  three  years.) 

A  chart  reading;    "Measles.      Cases  and  deaths  ilhisl  ral  iuii  the  dani^er  of 
measles.     \\\\\  overlook  il!'" 

A  eliart  showini;  :  The  milk  sn]iply  zones  and  the  (piantities  produced  aixl 
transported  in  March.  IIMJ. 


Divisiox  OF  Vital  St.vtistics.  Briii. At    ok  IIi.ai.tii.  1'iiii.ai)i;i.imii.\ 

Section  li.     li.iiilh  X...  K;, 

This  hoolli  contained,  almo^l  e\clnsi\-ely.  i;raphic  chart-,  and   maps  illn^l  rat  ini; 
the  following;  conditions: 

1.  ('li:irls. 

Deaths  under  one  year  of  age,  litll.     'I'olal  Ki.'iO. 

Preventahle  diseases,  '■2()()!) — H.ti  per  cent. 

Congenital  defects  and  accidents,  147!) — .'?-2  per  cent, 

Non-])revcntahle  diseases,  101,) — -i-l  per  cenl. 

Violence,  (iT      l.j  |)ereent. 

Total  deaths  from  all  causes.  -2(!.(M)-2.  litll. 

Non-])re\t'ntahle  diseases.  1:5, S.).') — .Vi.^  per  cent. 

Preventahle  diseases,  !), KIT — .'i4.!)  percent. 

\'ioleiice.  largely  preventahle,  1,007 — 0.1  percent. 

Congenital  defects  and  accidents,  largely  ])reventahle,  l,.}-2:i — .5.!S  per  cenl. 

Rirtiis,  Stillhirlhs.  and  Premature  Births.  1!)(K'  to  1011. 

Vital  Statistics  hy  Wards. 

\A  hite  hlocks  show  ing  mnnher  of  deaths  each  month. 

'■\\lK'n  Hahics  Die"—  Deaths  under  two  years  in  Philadelphia,  1011. 

Total  death.s  of  children  nnder  five  years  of  age.  also  maximum,  mininnim 
and  mean  temperature  and  rclali\'e  humidity  l>y  weeks  for  the  year  1010. 

Total  deaths  of  children  nnder  two  years  of  age.  also  maxinnim.  mininunn 
and  mean  temperature  and  relative  humidity  hy  weeks  for  the  year   1010. 

Total  deaths  |}er  1000  coni]iare(l  with  deaths  under  five  years,  under  two 
years  and  nnder  one  year  for  1011. 

Total  death.s  per  1000  of  ])opulation  comi)are<l  with  deaths  under  ti\e  years, 
under  two  years  and  nnder  one  year. 

Deaths  from  A\hoo])ing  Cough  under  two  years  of  age. 

Deaths  from  Scarlet  Fever  imd(>r  two  years  of  age. 

Chart  showing  the  numher  of  deaths  from  fifteen  (1,5)  selected  diseases. 


92         REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Relation  of  deaths  of  children  nnder  five  years  of  ajje  to  total  nioitaiity  by 
years. 

Deaths  from  Diphtheria  luider  two  years  of  age. 

Deaths  from  Typhoid  under  two  years  of  age. 

Deaths  from  Measles  under  two  years  of  age. 

Diphtheria,  5  years. 

Deaths  under  two  years  of  age  and  rates  jier  10(1. ()()()  of  ];o|itdation  at 
5-year  intervals. 

Deaths  from  Pneumonia  under  two  years  of  age. 

Deaths  from  Tuberculosis  under  two  years  of  age. 

Deaths  from  Diarrhoea  and  enteritis  un<ler  two  years  of  age. 

Hirths,   deaths   under  two  years  of  age   from   diarrlura   and   enteritis  in 
relation  to  density  of  po])ulation  for  the  year  li)0!). 

Deaths  of  children  imder  one  year  of  age  from  all  causes  shown  in  relation 
to  diet,  temjjeratnre,  and  humidity  by  weeks  in  sunnner  of  1!)10. 

Black  blocks  showing  the  number  of  deaths  from  various  di.sea.ses. 
"How  Babies  Die" — Deaths  under  two  years  in  Philadelphia,  1!)11. 

Two  Maps. 

Epidemic  of  Typhoid  Fever  caused  by  Break  in  Water  Main. 
Population  expo.sed,  10(5,000. 

C'a.ses  reported  Dec.  8,  1911,  to  Feb.  9,  191-2 367 

Deaths -27 

Per  Cent.  Fatal 7.36 

City  of  Philadel])hia. 

Location  of  Ca.ses  of  Typhoid  Fever  after  Break  in  Water  Main. 

Causes  of  death  under  two  years  of  age  during   1911.     Total   di-aths,  5769. 

Section  H.     liunth  Xo.  17. 

DivLsiox  OF  Child  Hygiene,  Bure.\u  of  He.\lth.  Philadelphia 

This  booth  contained  the  following  graphic  charts  and  photographs: 

Graphic  Charts. 

The  value  of  8  municipal  visiting  nurses.     Work  performetl  from  July  1, 
1910,  to  December  31,  1910. 


DIIUUTOliY  AM)  (  ATM.Oi.li:  (IF  IXIIIIUTS  93 

^  ;iliif  of  S  iiiinii(i|i.il  \  i-itiim  nurses.      AX'ork  iicrl'oiiiird  Ky  S  \  isitirig  iiiimi- 
<-i|);il  nurses  \\orkini;  in  wards  -,'.  :!.  1-  ,inil  ."),   IIH  1. 

Wild  wcinM  not  i-.itlirr  111'  a  liorsi'.'      i  Articl<'s.) 

Huw  is  your  lialiN'  li-d/      iSliou  iiiu  diilcirnt   inclliods.) 

The  Short   Hontc      'i'lic  Safe  Way. 
riic  Daiiucr  Zone. 

Showing  course  of  llie  milk  from  llic  --laMe  lo  eoiisiinicr. 
Dealli  has  marked  d/zroiil  of  vvrvy  Jiii   in  I  heir  first  \-ear  of  hi'e.      (  1 1  lust  ra- 
tion.J 

l'lii)t(if;ni|)lis. 
Race  Street   I'ier. 

Work  of  .Municipal  Xisilin^  Xurses.  I)i\  islon  of  ( 'hild  Hyiiieiie. 
Hureau  of  Health. 

Does  it  |:ay  a  cit\'  lo  speud  money  f<ir  nurses  and  pier  hospitals? 
A  few  of  I  he  many  results. 

Chestnut   Street    I'ii'r. 

Kecreatiou  I'iers  ii.sed  for  (are  of  IJahies. 

'I'ypical  1  nih'rfed   h'amily.      I'"lannel  Swaddling;  in  Suninier. 

Aiie  80  years.      .Vi^v  SU  days. 

They  ha\'e  the  same  chance  of  li\  inu  one  year. 

Instruct  ini;  a  Class  of  Mothers. 

School  (iirls  Learniui;  ('are  of  Haliy. 

Cleanina  Xursiui;  lioltlcs.     Washini;  Hahy's  Mouth. 

To  li\"e  under  an  awninii  on  the  roof  is  hetter  than   under  a   roof  in  the 
basement. 

^^  hat  Would  a  muuici|ral  \  isitin^'  nnrse  mean  for  this  famii\  !' 
The  answer. 

A  ]iicture  no  artist  can  ])aint. 

The  home  is  somewhat  harren.  hut  the  heart  is  (;oo(l  and  true. 

It  i.s  cheaper  and  hetter  for  a  city  to  dispense  Health  than  Charity. 

Poverty  will  al«a.^•s  exist. 

But  disease  need  not  he  its  eoniiianion. 


94         REPORT  OF  THE  PHILADELPHIA   BABY  SAVING  SHOW 

Sanitary  etlucation  is  better  than  sanitary  legislation. 

Are  they  worth  saving? 

A  (livisif)n  of  "Child  Hygiene"  is  the  logical  need  to  care  for  the  children 
of  all  nations  who  become  our  future  citizens. 

Graphic  Illustration. 
Ophthalmia  of  New-Born. 

Ignorance 
Caused  by     j  Carelessness 
[  Neglect 
Leads  lo  blindne.ss. 


Section  I!.     Booth  No.  18. 

U.  S.  Public  Health  and  Marine  Hospital  Service 

Tliis  booth  contained  the  exhibits  of  ihi'  I'nited  States  Public  Health  and 
Marine  Hospital  Serxice  and  of  the  Health  Department  of  the  District  of  Cohini- 
l)ia.  The  exhibits  in  both  divisions  consisteil  of  charts  and  tables,  and  in  the  latter 
there  was.  in  addition,  a  collection  of  illustrative  |)aniplilcts  and  leaflets. 


To  obtain  the  greatest  benefits  from  ])reventive  medicine,  we  must  begin 
the  Prevention  with  the  beginning  of  life. 


Infants'  Milk  Depots  in  the  United  States,  li»l(t. 
Milk-borne  Scarlet  Fever  Epidemics  (to  October,  1!)07). 
Infant  Mortality  in  the  Philippines. 

Table  comparing  the  Bacterial  Contamination  of  \'accine  Virus  Before  and 
Since  the  Enforcement  of  the  Act  of  Congress  ai)])roved  July  1,  1902,  im]jos- 
ing  upon  the  Public  Health  and  Marine  Hospital  Service  the  Federal  Con- 
trol of  Viruses,  Serums,  etc. 

\ariali(iH  in  Methods  of  Testing  Tetanus  .Vntitoxin  liefore  tlie  promidga- 
tion  of  the  Standard  Unit  originated  by  thi'  Public  Health  and  Marine 
Hospital  Service. 

^^ilk-l)()rne  Typhoid  Fever  Ei)idemics  (to  October,  1907). 
Milk-borne  Diphtheria  Epidemics  (to  October,  1907). 


DIRECTOliV  AM)  (  ATM.iX.lE  OF  KXIIIIilTS  95 


Health  Department  of  the  District  of  Columbia 


"Discoiitriil  uilli  dirty  and  iiiiliytricnic  siirroiiiidiiiiis  is  nl'lriil  iiiu's  the 
very  !)(•-.(  ins|)lraliiiii  lor  liririiritii:  nli<iiil  liic  cniidiliiiiis  llial  make  for 
h<-ailli." 


(fnii)lii<-  <  'liarts. 

Estimated  ()frs])ring  of  one  fonialc  fly   dmiiii:  seasons — from   A|iiii    10   to 
Sei)teinl)er  I(i-    Total.  K/-'?.'!, (IS  t. -21 1.' 

(iraphic  ("hart  slmuiiit:: 

Birtli  Hate  i)er  1. ()()().      While. 

Pereeiilafje  of  deatiis  of  Inl'anis  iindei-  1  year  to  reported  li\c  Hirllis. 

Birth  Rate  ])er  1. (too.     Colored. 

Percentage  of  deal  lis  of  Infants  under  1  year  to  re|)orled  li\ c  Mirliis. 

Visiting  Niirsi*  W'lirl;. 

Prevention  of  Infant  Mortality.     Samples  of  the  educational  pamphlets 
and  leaflets  used  for  (list rihut ion  t>v  tiie  X'isiting  Niu'ses  of  tlie  tlepartment. 


Diseases  Other  Than  Communicable 

Section  C.     Hndlli  Xo.  19. 

I'his  section  consisted  of  tlire<>  hooths  eontainini;  chiefly  colored  drawings  of 
the  non-conununical)Ie  diseases  which  result  in  deformities  or  lesions  which  can 
readily  lie  recognizeil  hy  the  average  layman.  In  the  main  they  referred  to  con- 
ditions which  are  likely  to  he  neglected  hy  mothers  of  the  ignorant,  or  overlooked 
hecau.se  of  the  insidiou.snes.s  of  their  on.set  and  their  failure  to  i)ro(iuce  acute  mani- 
festations. There  were  a  few  additional  drawings  illu.strating  certain  acute  in- 
fectious conditions,  such  as  ophthalmia  neonatorum,  which  demand  immediate 
medical  attention. 

Colored  Drawings  Illustrating: 

Diseases  of  the  Xervou.s  System. 

Paralysi.s  of  the  nerve  of  the  face  from  exposure  to  cold. 

Infantile  hrain-paralysis. 

Tetany. 

Inflammation  of  the  nerves  following  Diphtheria  and  the  use  of  .Vlcohol. 

Palsy  of  hand  anil  arm. 

Spinal  Paralysis. 


■A 


■A 

A 


96 


niHFj  Tony  wn  (  atm.iu.ii:  or  i:\iiiiiirs  97 

Six  Colori'd  DiMwinys  lllnstratiii^: 

One  \(>riii;il  and  I'ivc  Aluioniial  St()()l>.  tlio  Lai  tcr  t  lie  IU--11II  iil'  Iiri|iio|)cr 
Fcodiiif^. 

Weight  curve  sliowiiiL;  loss  I'roiii  siiiiinier  (liairli<i'a. 

Jaw  and  Icelli  sliowiiit;  rllccl  of  t liiiinli-suckin;;  or  coiiit'orter. 

Intestinal  Worms: 

A.  Tapeworm — (a)  derived  from  pork  and  heef;   (h)  derived  froni'lisli;    (c) 

derived  from  do<;,  cal  and  lice. 

1$.    riiread  worm. 

('.    lionnd  worm.  Iicaij  andeij;iis. 

Infantile  Scnrvy. 

Disease  of  the  Kidney. 

Dropsy. 

Weiiiht  cur\c  showing  effect  of  acute  milk  infection. 


Section  ('.     He... Ill  \...  '20. 

I'alile  sliowiiii;  averaue  weights  and  heights  (hoys  and  ^irls). 
'rai>l<'  showini;  relation  of  weiulit  to  ^■itality. 
(\)lore(l  drawint;  illnst  rat int;'  di.seases  of  the  skin. 
Photographs  sliowint;-  '■(■atchy  .sores"  and  eczema. 

Colored  drawings  illustrating  adenoids,  (a)  Adenoid.s — nioutli-hrcathing 
— narrow  chest;  (h)  j)()sitioii  of  the  adenoids;  (c)  adenoids — j)re.sent — re- 
mo\  cd.      (l'hotogra|)hs.) 

O.Iciv.l  Diawiiii;^. 

Throat  showing  I'',nlarged  Tonsils. 
Chihl  with  Knlargecl  (dauds  of  Neck. 
Child  with  Mastoid  Ahscess. 
Child  with  Stifi'  Xeck. 

(.'..lured  l)nnviiif;s  Illuslnitiug: 

Rickets. 

Cjiild  with  l)ow-legs. 

Child  with  curvature  of  the  s])ine. 

Chilli  with  all  of  the  deformities  of  rickets. 

Child  with  "\wi  helly." 

Colored  Drawings  Stiowing: 

Conditions  of  the  Mouth. 

Sim])le  inflammation  of  the  mouth. 

Thrush. 

Inflammation  of  the  mouth  with  ulcers. 

Deep  ulceration  of  the  mouth. 

Gangrenous  stomatitis. 

Showing  eru])tion  of  first  teeth — "First  Dentition."" 


98 


REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


Colored  Drawings. 

Normal  sitting  position. 

Posterior  spinal  ciirvatnre  from  sittini;  too  soon. 


Photographs. 

Birthmarks. 

Itch. 

Shingles. 

Ringworm  of  the  skin. 

Ringworm  of  the  scalp. 

Cold  sores. 


Section  C.     Booth  No.  ••21.     (See  Plate  XXX.) 

Chart.  ' 

Pneumonia  frequently  follows  Bronchitis. 

Measles. 


Whooi)ing-cough. 

(;ril>]M'. 

Diphtheria. 

Acute  Diarrhoea. 

Scarlet  Fever. 

Chickcn-])ox. 

Ervsi|)elas. 


Cciliiic'il  Drawings. 

Cretins. 

A  cretin  lief  ore  treatment. 
A  cretin  after  treatment. 


Two  Photographs. 

Cretins. 

Colored  Drawings. 

Diseases  of  the  eye. 
Pink  eye. 
Trachoma. 
Sore  eye  at  birth. 

Stye.  ■ 

Colored  Drawing. 

Child  with  marasmus. 


Colored  Drawing. 

A  hand  showing  clubbed  fingers  from  congenital  heart  disease. 


DIIIFA  TOUY  AM)  (  ATAIJXiri-:  OF  FXIUIUTS 


99 


(ol.nr.l  I  )ra\\  in^'s  of  ( 'liilcircri. 

Illiisl  raliiii^-  llic  lollowiiiff  tiilxTciilmis  lesions: 
'l"iil)i'rcul()sis  of  till'  dhow, 
'riihcrciilous  hip  diseaso. 
'riil)onnlosis  of  the  knee. 
Tiilierciilosis  of  tlie  ankle-joint. 
Earl\'  liilKTciHosis  of  the  spine. 
'I'uhereulosis  of  the  sjjiTial  roluniii. 
'rnherenloiis  peritonitis, 
'rnherctilons  inflammation  of  the  hiain. 

(  (ill. nil  Drawilifis. 

(  hildrcn  w  ilh  : 
IJow-l.-s. 
Conyenital  dislocation  of  holh  hips. 

Two  <'i)|cinMl  Drawings. 
Di.soases  of  the  hoiie.s. 

(inipliic  Cliart. 

Sliowing  causes  of  death  per  1,0(1(1  in  lirsl  \carof  life,  from: 
Unknown  diseases. 

Diphtheria,  \vhoopilii;-conL;h,  measles,  scarlet   l'c\-er. 
Tiihercidosis,    pn<'nmonia,    and    oilier    inllammatory    respiratory    dis- 
eases. 

Congenital  weakness  and  dehility. 
Other  known  diseases, 
(iastro-iideslinal  iliseases. 


Coluri'ii  l)niuini,'s  llliistratin": 


Hare-lip. 

Cleft -palate. 


100 


CO 


101 


Q 
O 
O 

H 

< 

'A 


'J. 


O 
is 


o 


w 

X 
u 

o 


w 

D 
m 

H 


102 


DIRF.(  TDHY  AM)  (  ATAlJX.ri:  OF  FMHIIITS  103 


U.  S.  Department  of  A^TicuItu re 
Hu red u  of  Chem  istri/ 

\>r,-  I'l.ltr   \.\\I| 
Srrliini  <'.       I!n.,lli   \,,.  ■,'-,'. 

Til  is  IxKil  h  roiil.iiiii'il  I  III'  Idlliiw  iiii;  ell. -iris  show  iiij; : 

The  coiiipd^il  inn  ul'  dilVrrcnt  |)r(i|iri('l;iry  i'ooiU  lor  tlircc-inoni  lis-old  liahy, 
(•(imi)ar<'cl  uilli  inolhcr^'  milk. 

('()iii])osilioii  o!  foods  for  infants.      (^Sce  I'latr  XXXII. j 

Infant  foods,  cereal  hasis. 

("oinposil  ion  of  fornndas  for  child  tlircc  inonlhs  old. 

i'rc|>arc(l  Ky  the  addition  of  milk  and  water. 

Infant  foods,  milk  liasis. 

Composition  of  foi-nndas  for  child  three  months  old. 

Prepared  li.\'  the  addition  of  water  onl.v. 

Infant  foods,  cereal  and  milk  hasis. 

('onil)ositioii  of  formulas  for  child  tlii-ee  monlliN  old. 

Prei)arecl  li\-  the  addition  of  water-  only. 

Milk  basis  infant  foods. 

Composition  of  formnlas  for  child  three  mont  h>  old. 

Prepared  hy  the  addition  of  milk  and  water,      i  See  l'lat<'  XXXill.) 

Cereal  and  milk  liasis  infant  food-,. 

Composition  of  formnlas  for  child  three  months  old. 

Prei)ared  h.v  the  addition  of  milk  and  w  ater.      iSee  Plate  XXXIII.) 

Miscellaneous  infant  loo,U.      i  See  Plate  XXXIII.) 

'rhirt\'-tw(i  liollles  Nhowinn  various  infant  foods. 


104 


niRECToRY   iM)  ( .iT.tijx.rr:  or  i.xninirs  105 

Phihidclphid  Fcdidtric  Socicfi/'s  Milk  Commission 

|S,T   !'l:,lr  XWUj 

Si'clioii  <'.     Hiicili  \...  -J.-i. 

'I'll!--  Koolli  ((irilaincd  llic  follow  iiii;  cxhiliil-: 

A  iliaiir;iiiiiii;il  ic  clinrl  illiisl  pmI  iiii;  llic  i;rcalcr  clliciciicy  of  llic  lioinc-iiiailc  ice- 
box ill  k(<"|iiiifi  milk  as  i-oinparcd  w  it  li  I  lir  ordinary  types  of  refriyerator.  liie  ii|)]ier 
lialf  of  this  cliart  I'onlaiiied  an  illii->t  i-atioii  of  a  <T()ss-sectioii  of  an  ordinary  refrig- 
erator, showiiiu  tlic  four  section-  in  which  it  would  he  po-.sili!c  to  keep  milk. 

The  milk  liefore  lieinir  i)lace(j  in  these  \arions  com|iartnients  was  found  to 
contain  ',',S,'i.(t()()  hacteria  jier  c.c.  At  tlie  end  of  -l\  lioiirs  the  mimlier  of  liacteria 
had  iiicrca-e(l  in  these  compartments  as  follows:  Compartment  1— '■2,4!li).()0()  per 
e.c.;  comparlmeiit  '2-  :5,(i-2().(l(l(>  per  c.c.:  compartment  .'5  ,'5(),.5'-2S.(l()()  per  e.<-.; 
comiiartmeiit   I-     '■2()..'5;5!).()0()  ))er  c.c. 

In  the  lower  half  of  the  chart  there  was  shown  a  cross-section  of  an  ordinary 
chea])  home-made  icc-lio\  of  the  kind  on  exhiliition  heneath  tlie  chart,  eontainiiii; 
Imt  one  compart  m<nt .  The  niimlx-r  of  bacteria  per  v.r.  in  the  milk  before  beinj; 
l)laced  in  this  ice-box  was  '2<S:i, ()()(),  and  at  the  end  of  '2  t  hours  it  had  only  increased 
to  ,'i;>!l,(l()()  jier  v.v.  To  preserve  the  milk  in  this  condition  for  "24  liotirs  it  re(|iiiro(l 
bnt  ti\c  cciils"  worth  of  ice.  This  test  was  carried  out  at  the  Henry  I'hipps  Insti- 
tute. .Ml  specimens  of  milk  were  taken  from  the  same  sample,  and  all  experiments 
conducted  on  the  same  da\.  the  niaximiim  olhcial  Icmpcraliire  for  the  da\'  bcint; 
73°  F. 

There  were  in  addition  a  lari:i'  number  of  photograph-  illii-t  rat  iiii;  the  ccrtili<'d 
milk  plants  and  their  nietho<ls  of  procedure,  and  chart-  illii-tratint;  the  chemical 
anti  bacteriolo.uii-al  n'sults  of  the  examinations  of  certified  milk  in  the  \arions  farms 
covering'  the  period  of  a  year,  and  ilhi-lralinu  the  methods  employed  b\'  the  Com- 
mission to  secure  its  results. 

There  was  also  a  chart  gixiiig  lli<'  rc-nll-  of  some  iinest igatioiis  of  market  milks 
wliicli  was  show  11  for  the  sake  of  comparison. 

There  were  two  charts  giving  a  coni])arison  of  tlie  nuniber  of  cases  of  tubercu- 
losis canse<l  by  the  human  type  of  the  tubercle  bacillus  with  those  caused  by  drink- 
ing milk  from  tiiln'rcnlou- cows. 

In  the  center  of  the  liooth  was  ])laced  a  i)yraniid  of  certifierl  milk  and  cream, 
bottles  sealed  and  certified  as  recpiired  by  the  Commission.  On  the  front  of  the 
stand  bearing  this  inramid  was  a  frame  containing  the  seals  used  by  the  various 
producers  of  certified  milk,  and  at  the  side  of  the  stand  was  shown  a  consumer's 
receptacle  for  receiving  bottled  milk  (I'.  S.  Department  of  Agriculture)  and  the 
capping  anfl  sealing  device  used  in  bottling  certified  milk. 

Philadelphia  having  recently  had  a  Milk  Show,  in  which  all  the  avenues  that 
milk  must  follow  from  the  cow  to  the  consumer  were  fully  demonstrated,  the  .subject 
of  milk  was  much  less  extensively  gone  into  in  this  Show.  ^Ye  did.  however,  aim  to 
em|)hasize  two  features  which  we  felt  had  a  special  bearing  u\w\\  infant  health, 
namely,  the  source  of  supi'ly  and  the  i)roper  method  of  receiving  and  earing  for  milk 


100 


DiRFJTonv  AM)  ( .\TM.()(,ri:  or  i.xiuiurs  107 

ill   llic  lioiiic.      'Ilic  snlijccl    iif  |)i-ii(lii(i  iciii   ua~   lipiiclicil   iipdii   in   the  cxliil)!!  ion  i>l' 
tlircc  txpcs  of  (lain'  harns  wliicli  wwr  loaned  liv 

THK   I'F.WS^LVAM A   S'lAI'K   I,l\  KSIOCK  SAMTAin    UOAHO 

'I'licsc  nioiicl-  were  placcil  in  alcove-,  al   Ihc  ca^liTn  rml  ol  llie  linildini;.       Tlu-y 
\\  <'r(' : 

1.  A  model  ol'  a  liail  lyiieof  larin  liarai  ii-.ed  For  dan'V  inn'poscs.  ^  ard. 
burn,  and  >lalile  liltliy;  poor  lii;lil  and  \  cnl  ila  I  ion ;  \arions  kind^  of 
liveslock  crowded  toyclhcr. 

2.  A  model  of  ;i  iioo<l  lype  of  farm  l)arn  ii^cd  foi-  dair,\'  purposes.  i'"air  eon- 
sfrnetion:  clean  stalile.  yard,  anri  eal  I  le;  i;ood  liL;lil  and  xcntilal  ion:  ijood 
slancliions;    eows  separateil  from  ollici'  li\'e..|oek. 

I).  A  model  of  an  <'\cellent  lype  of  modern  daii-y  liaiai,  Sanilarx'  con- 
.struelion;  clean  slai)le  and  cows;  ade(|nale  li;^lil  and  \cnlilalion;  no 
other  livestock.  A  saiiitar\'  milk-can  and  a  metal  milkinu-slool  weic  on 
exiiihilion  heside  this  model. 

No.s.  1  and  'i  were  models  of  the  oi'dniary  liank  liarn  Ihe  liarn  mo>l  com- 
monly fonnd  in  the  State  of  IViiiisylvania.  No.  i  showiiij;-  a  method  hy 
wliich  this  tyjie  of  liarn  c;in  he  comcrtccl  into  a  perfectly  sat  isfaclor.x'  and 
.sanitarx  liarn. 


The  Care  of  Milk  in  the  Home 
Si-.-ii.Mi  c.  n.Miiii  N,,.  ■,>+.    is.T  rtair  WW.) 

This  hooth  relati'(l  almost  exchlsiveiy  to  the  care  of  milk  in  the  home.  Tlie 
([nestion  of  |)roduction,  howexcr.  was  tonched  upon  liv  the  exhiliition  of  scxcral 
photoiiraplis  illustratinii;  the  interior  and  exterior  of  d.iiry  farms  of  the  hetti-i'  type. 
and  a  grapliie  diagram  (Cliicago  Hoard  of  Health),  (Mititled,  "The  lonu  and  the 
.short  haul."  which  ])oiiited  out  tlie  extcn^ixc  treatment  that  milk  reccixcs  from  (he 
time  it  leaves  the  cow  until  it  finally  reaclx's  the  infant.  This  was  coni|)are(l  with 
an  infant  receiving  the  milk  direct  from  the  cow. 

On  two  shehe.s  placed  in  the  fi-oiil  of  this  hooth  was  a  xcry  eti'ectix'c  graphic 
demonstration  of  the  right  and  the  wrong  w  a\'  of  caring  for  milk  in  Ihe  home.  Ihe 
following  .sets  of  legends  being  iilaced  inun<'<|ialely  back  of  the  articles  n>ed  in 
ilemonslralion; 

On  Itic  uppL'r  .slielf,  illustrating  tlie  correct  mcthdil: 

"Take  the  milk  from  the  milkman  yourself,  or  ha\e  a  box  like  this  for  him 
to  put  it  in."      (  Placed  above  Ihe  pro] )er  kind  of  box,  containing  bottles.) 

"\Mu-n  you  receive  the  milk  from  the  milkman,  jiut  it  on  ice  at  once." 
(Placed  above  a  home-made  ice-box.  cut  in  half,  illustrating  the  eheaimess 
of  construction  and  the  pro|ier  |iositionfor  the  milk.) 

"When  you  make  the  milk  mixture  for  your  baby,  see  that  all  your  utensils 
are  clean."  (Phiced  abo\e  two  bottles  of  milk  and  the  necessary  uten.sil.s 
in  clean  condition.) 


108        REPORT  OF  THE  PHILADELPHIA  BABY  SAVLXG  SHOW 

"111  iiiaking  uj)  milk  mixtures  for  your  l>iil)y  use  hoiled  water  that  has  been 
cooled.  After  you  have  used  what  milk  you  want,  cap  or  cover  the  bottle, 
and  put  it  hack  on  the  ice  at  once."  (Placed  aliove  a  refrigerator  con- 
taining the  milk  in  bottles.) 

"Wlien  milk  bottles  are  em]jty,  wash  tlicm  with  snap  and  water;  rinse 
them  with  cold  water,  and  then  scald  them  with  boiling  water."  (Placed 
above  the  utensils  necessary  for  this  jirocedure.) 

"Place  emjjty  l)ottles  in  a  clean  box  with  a  lid."  (Placed  above  a  clean 
milk  bottle  receptacle.) 

"A  suitable  mixture  for  an  infant,  prepared  from  milk  taken  care  of  in  the 
manner  al)ove  described,  when  examineil  bacteriologically,  was  found  to 
contain  lint  &2iU)  bacteria  jier  c.c."  (This  legend  was  placed  above  a 
baby'.s  bottle  filled  with  milk.) 

On  the  lower  shelf,  illustrating  the  incorrect  method: 

"Do  not  let  it  stand  on  your  .steps  in  the  sun."  (Placed  above  two  milk 
bottles  standing  on  a  doorstep.) 

"  Do  not  leave  it  on  the  kitchen  table.  "  (This  was  i)Iaced  aliove  some  milk 
bottles  surrounded  by  \ari()us  unwashed  kitchen  utensils.) 

"Do  not  use  dirty  bottles,  bowls,  or  glasses."  (This  was  j)laced  above  a 
group  of  dirty  utensils  difficult  of  cleansing.) 

"Do  not  use  un])oiled  water  to  dilute  the  milk  for  the  baby's  bottle.  It  is 
full  of  germs. "  (Placed  above  a  kettle  standing  beneath  a  sijigot,  and  be- 
side some  milk  bottles.) 

"Do  not  leave  it  on  the  table,  where  flies  can  get  in  it."  (Placed  above 
some  ])artially  em])tied  bottles  with  the  caps  off,  the  bottles  being  covered 
with  artificial  flies.) 

"  Do  not  throw  the  emi)ty  bottles  down  anywiiere.  "  ( Placed  above  several 
bottles  lying  on  their  sides,  amid  such  articles  as  an  old  liroom,  a  broken 
box,  and  some  scraj^s  of  dirty  paper.) 

"A  mixture  made  from  the  same  kind  and  (|uality  of  milk,  and  secureil  at 
the  same  time,  and  having  the  same  bacteriological  content  as  that  used  in 
the  up]5er  row,  but  cared  for  in  the  careless  manner  indicated  in  this  row, 
was  examined  and  found  to  contain  '•27,100  Inuteria  per  c.c." 

In  addition  to  the  foregoing,  the  following  charts  were  hung  on  the  walls  of 
this  booth : 


Milk  not  kei)t  on  ice  is  unsafe  to  use. 

Make  vourself  an  ice-box  if  vou  lunen't  one. 


DIHFJ  TORY  AM)  (  ATM.tH.l'i:  OF  F.XIfllilTS  109 


It  is  till'  iliitx-  111'  llic  Munici|),ilil\-  In  -cr  that  vmi  uct   I'lirc,  ('lean,  Frc>li 
.Milk. 

It  is  I/our  duty  to  see  tliat  it  is  kept  I'lii-e,  (lean,  aiul  Fresh. 


Tell  your  inilkuiaii  In  deliver  .\oiir  milk  lo  you  I'rrsoiuilbi. 
])()  uol  lei  liiui  leave  il  on  \iiur  door-slei). 


Dnll 
]),„i 
Don 
Ihui 
Dnii 

Don 
Don 
Don 
Don 
Don 

Don 


MILK    -DON   rS" 

/  liu\'  milk  unless  you  are  sure  llial  it  is  clean. 

N'xpose  milk  or  its  container  to  the  ^nn. 

/  put  milk  in  a  \essel  that  has  not  previously  heen  scalded. 

/  cook  milk  in  vessels  that  are  used  for  other  |)urposes. 

/  keej)  milk  in  the  same   eoniparlmeni   of  the  refrii;erator  with  other 
I'ataliles.      Milk  ahsorhs  odors  as  well  as  germs. 

/  leave  a  milk  liottle  uue<ivered. 

/  leave  the  milk  I  ml  lie  unw  ashed  after  use.     A\'ash  it  at  once. 

/  fail  to  rinse  the  hottle  in  cold  water  before  scalding. 

/  rescue  dying  flies  from  the  milk  and  then  use  the  milk. 

t  accuse  the  milk  dealer  of  serving  sour  milk  until  you  have  investi- 
gated your  home  handling  of  it. 

/  forget  that  ice  is  the  best  preservative  for  milk.     See  that  it  is  ahont 
the  milk  container,  instead  of  heinu  eaten  1)V  the  children. 


nu 


DiRKcTony  AM)  ( ATM.iu.ri:  or  rxiiniirs  in 


Infant  Feeding 

The  exliiliits  (111  infant  feediiii;- ()ccii|iieil  six  linoths:  The  first  colltailieil  all  the 
utensils  wliicli  imild  |;ussilily  lie  needed  in  tiie  |ire|iai'ati(in  and  care  of  tiie  milk; 
the  second  cdnlaincd  a  deincinst  laticm  cif  ludd  \aines;  liic  liiird  was  dcxnted  to 
artificial  feeding;  the  fdurlji  was  fitted  n|i  a-'  a  |iiain  Uitilien;  and  tlie  fifth  and 
sixth  w  ei-c  (lc\  ( ili'd   liilirea^t   IccdlUL;. 


UTENSILS  USED  IX  1X1  ANT  FEEDINC; 

Scclioii  I).     H....I1,  \,,.  .,>i;.     iS,-c- I'l.-ilr  WW  I.) 

( tn  t\Mi  ^licjvcs  on  the  left-hand  screen  were  |:laced  thirleen  jars  c<intainili<; 
li(iric  acid.  Iiarlcy  tureen-.,  rice.  Iiar](\\'  llcini'.  (latmeai,  junket  taliK't^,  sdur  milk 
talilets.  rrnncl.  dc\trnn/mu  fcrnicni.  i^i'ainiLi  led  ~iiL;ai'.  mall  -.ni:ar.  milk-sUfiar. 
and  ii(ira\. 

( )n  t  lie  shcl\ cn  (in  t  lie  center  sci-ecn.  and  (in  a  kir.ue  sliclf  extending  ardimd  t  lie 
frcint  and  sides  (if  the  lidcilh.  wci'c  placed  twd  home-made  ice-ihcsts,  ;i  hy^^ienic 
refrificratiir.  ,i  tireless  ciioker.  a  small  liand  elm  in.  a  liot  fie  warmer,  a  (  liapin  dipper. 
a  Freeman  pasteurizer,  graduate  i^lasses.  strainers,  ddiililc  liciilcrs.  |iifchers,  and 
saucepans  made  of  ajiatewarc.  a  numlier  of  small  liowls,  spodiis,  a  pair  of  scales, 
and  varidiis  additional  articles  which  niiuiit  lie  used  in  the  pn'paralion  of  infant 
foods. 

On  the  center  screen  were  liunu'  foiu'  charts  lieariiii;  drawiui^s  df  ntcn-,i|s,  ;ind 
the  melhdd  df  usiui;-  them  in  the  preparatidii  (if  liarlev  water.  wIkiIc  (ir  tup  milk 
mixtures,  wlicx',  and  artificially  -din-ed  milk. 

'IIkm'c  were  alsd  sluiwu  utensils  iiecess.ir\'  fur  the  carrying'  out  df  a  cheap  method 
of  lidiiic  pasteurization,  and  alxivc  il  Imng  t  he  fdlkiw  iiig  chart : 


Mcih 

(1(7 /or  Home  Pasteurization 
Articles  X ceded 

One  kettle 
One  kettle; 

large 
ilidiit  t 

enough 
wice  the 

to  hold  eight  bottles  standing  ujirig 
size  df  the  first,  with  a  cover. 

ht. 

Method 

Place  bottl 
with  cold 
boiling  wat 
from  the  fi 
out  liottle.s. 

.'s  eoni 
water, 
er,  an 
re,  let 
cool  r< 

aining  the  milk  mixture  in  the  small  kettle. 

Place   this  in   the   large  covered   kettle,   1 
1  allow  to  simmer  gently  for  eight  minutes 
stand  for  one-half  hour  (keeping  covered), 
ipidly,  and  jilace  on  ice. 

Nearlv  fill 

lalf   full  of 

Remove 

Then  take 

112       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Above  the  lionie-inade  refrigerator  was  a  gra|)liic  cliart,  in  the  center  of  wliich 
was  a  (h-awing  of  a  cross-section  of  a  refriii'erator  witii  the  ])rei)are(l  Ijottles  in  the 
position  which  tliey  sliouhl  occu])y.     Aho\e  this  was  written: 

A  IIOxME-MADE  Refrigerator.     Cost  35  Cents 

Beneatli  it  apjjeared  the  following: 


TO  MAKE 

Buy  an  enii)ty  biscuit  tin  Qi  2  inclies  hiuli  x  \i  inches  wide,  at  tlie  grocery 
store. 

Buy  a  tin  bucket  8^2  inches  high  x  7^  2  iuches  wide. 

Buy  a  wooden  l)ox  16  inclies  square. 

Fill  the  box  as  indicated.     It  will  hold  all  feeding  bottles  necessary  for 
twenty-four  hours. 


The  two  following  charts  completed  the  exhibit  in  this  booth: 


PASTEURIZATION 

By  this  method  milk  is  heated  to  a  temperature  of  from  140-14.5  degrees 
Fahrenheit  and  kept  at  this  temjjerature  for  30  minutes.  The  milk  is  then 
cooled  ra])idly  in  running  water  and  put  on  ice  in  the  refrigerator.  Milk 
so  ])rei)ared  and  kc]>t  directly  on  ice  will  remain  sweet  and  wholesome  for 
24  hours. 

Certified  milk  does  not  need  Pasteurization  during  the  winter  weather, 
but  all  milk  for  young  or  sickly  infants  should  be  Pasteurized  during  the  hot 
weather  of  the  summer  months. 


STERILIZATION 

By  this  method  milk  is  heated  to  a  temperature  of  212  degrees  Fahrenheit, 
either  in  a  s|)ecial  apparatus,  such  as  the  Arnold  Sterilizer,  or  by  bringing 
it  to  the  boiling  jjoint  in  a  kettle  or  saucepan.  Neither  method'is  so  good 
as  Pasteurization. 

Dirty  milk  or  half  spoiled  milk  cannot  be  made  pure  by  any  method. 


DiUKcTony   iM)  (  ATM.oari:  of  kxiiihits  iuj 


Foods  and  Food  Values 

Section  D.     li-nth  \...  -JS. 

This  l)i>i>tli  was  arraiiiicd  to  <li>|ilay  llic  xarioiis  t'oi  nisi  nil-  siiitalilc  to  iiitaiicy 
and  early  cliildliood  and  to  show  siiii|ily  aii<l  clearly  theii-  relali\'e  calorie  values. 
The  exhibit  consisted  essentially  of  i;i'adnat<-(l  cylinders,  hollies  and  jars  containinii 
colored  fluids  or  foods,  ])ro])erly  lal>ele(l,  and  arraniied  on  shelves.  'I"he  remaining; 
s|)aees  on  the  three  screens  allotted  to  this  Section  were  occupied  hy  explanatory 
charts,  food  charts,  and  appropriate  decorations.  There  is  no  ueneral  view,  hut  the 
l)hites  with  the  explanatory  Iciicnds  show  the  itnporlani  features.  'I"he  charts  and 
specimens  will  lie  descrilied  without  reference  to  their  jiosilion  on  the  .screens. 

I)i-,(.r;ilivc  I'riilts. 

••Fiv<'  O'clock  'I'ea"  i.l.  W.  S.l;    "Suoar   I'luni   Tree"  :M.  1'.  -    -  Manihini  "    ilella 
Rohhia). 

Cluirt.s  <if  Dcpnrlinciil  of  Auriiiilliin — ( 'onip  isition  of  Kood  MaliTiajs. 
'"K^fi'^  :i'i<l  Cheese"";    "Hntlerand  Other   Kat-\ieldin;i   Foods"";    "Snuar  and 
Similar  Foods";    "Roots  and  Succulent  Veuetahles."      i  See  Plate  WW  I II. )     On 
another  screen  :    "  ( 'omposit  ion.  I'"nnct  ions  and  I  ses  of  l^'oods";    "Cereal  drains"; 
"Bread  and  Other  Cereal  Foods";    ".Milk  and  Milk  Products."" 

EN])I:inMlory  Cliarts. 
These  enumerate  the  principal  foodslnffs  ari<l   define  their  uses  and   indicate 
the  prin<iples  ujion  which  the  calorie  method  of  valuing  foods  is  based. 

ClKirt  1. 


PROTEIN  :\rOST  ESSFATT.VL  FOODSTTTF 

No  Substitute  can  replace  it  for(.ROWTII  and  RF:P.\IR 

1,.\CK  of  PROIFIN  had-  to 
ANEMIA,  POOI{  (  IR(  I  L.VTIOX,  FL.V15I5Y  MUSCLES 

ST.VRCIIES  and  Sl'CARS  (Carbolivdrate) 

CHEAP.  EASILY  I)I(;f:STED— Sujiplv  IIFLVT  an.l  MLSCl  LAR 

POWER 
LACK  OF  SUGARS  and  STARCHES  leads  to 

LOSS  of  WEICHT  and  STREXCTH. 

AV.VTER 
Nearlv  !)()  PER  CENT  of  INFANTS"  FOOD  (HU.MAN  MILK) 
CHILD  of  one  YEAR  needs 

HALF  as  much  WATER  as  ADULT. 

MINERAL  SALTS,  etc. 
Found  in  FRUIT  JUICES,  GREEN  VEGETABLES,  UNROLLED 

:milk 

LACK  of  ])roper  SALTS  causes 
ANEMIA,  SCURVY,  RICKETS 


i- 
y. 


a 

< 

Q 
a 
Q 


114 


DIRK(  TORY  AM)  ( MAIJX.IF.  or  KMIIIillS  115 

Chart  i.      (I{,•f,■I■^  to    I'lalr  WWII) 


BABY  need 

s  ill 

I'HOI'OIMIOX 

Id 

iil- 

\\ 

■i-hl 

FOl'R  timos  as 

iiiiii' 

1  W A  TEli  : 

,.  1 

li- 

III! 

llu-i 

V\\\\  times 

as 

imch 

VXV  a>  Im> 

IlK 

.11 

cr 

TWICE  as 

niK 

li  (1 

HI)  1  prolciii  1 

IS 

his 

mot 

KT 

EQUALLY 

as  iniicli 

SrCAK  1st 

an 

Id 

as 

liis  motluT 

(Mother  tis( 

s   St 

anil 

ami  --imar.  1 

ah 

\'  > 

iiu; 

ir  oil 

l.v) 

ClKirt  3. 


I'OOnS  ate  BIHXEI)  in  the  W^\^\    as  COAL  iiii.icr  a   BOILER 
MrMiim  BO|)^    IIKAT  and  MLSC  ri,Al{  TOWEH 

jiisl  a^ 
COAL  viekls  Sl'EAM  HEAT  and  I'OWEU 


OIL  makes  a  HOTTER  liiv  than  (  O  AL  or  \V(  toj) 

FAT  yields  (iREATEH  IlKATaiNl  i;M;K(iV  than  other  KOOnSTlEES. 

PROTEIN  (Curd)  and  <  ARKOll^  l)|{  A  IE  (sugar  or  stareiii 

liavc  same  YALUE  as  HEAT  l'R(  )l )!(  IlKS 


The  MEASURE  of  HEAT  is  llie  CALORIE 

ONE  PART  l.v  WEICHT  (I  gram)  of  PROTEIN  \\A<U  t  .alorics 

"        ■•  FAT  ••      !)     " 

..   CARBOHYDRATE    "      4     " 

A  baby  re(iuires  40  to  .JO  calories  for  each  ])Oiind  of  weight 


One  quart  of  Milk  contains  (roughly) 

Curd  (Protein)    .'!.j  grams  x  4  =  140  calories 
Fat  40       '•       X  0  =  ;5(iO  calories 

Milk  Sugar  4,'>       "       x  4  =  180  calories 


(ISO  calories 


Graduated  Bottles  and  Jars. 

The  purpose  of  the  exhibit  shown  in  Plate  XXX\  II  is  exi)lained  by  the 
legend: 

Chief  Foodstuffs  in  Amounts  Needed  at  Different  Ages:  Baby  10  AVeeks 
old.  Weight  11  lbs.  Child  13  mos.,  AVeight  2-2  Ibs^  Nursing  Mother— 
110  lbs. 


z 

Q 


Q 
O 
O 
li 

O 

a 

D 

< 

H 
D 
Z 


116 


DIHFA  TORY  AM)  (  ATMMi.lF.  Ill'  IXIIIIUTS  117 

Fur  tacilily  in  ((Hiiparisoii  woiiilits  that  were  siiiiplc  niiilliplfs  of  11  wore 
takoii  for  the  older  liahy  and  iiiotlier.  Water,  colored  red,  represented 
protein;  colored  yellow,  fat;  colored  lilue,  earlioliydrale;  niicolored, 
water,  (iihic  eeiitinieters  re|)resenled  i;ranis  liy  wciiilit.  Mineral  sails 
were  represented  Ity  connno!i  salt. 

The  graduated  eylindi'rs  and  liottles  contained,  in  order:  l'rot<-in  I  1.5 
grms.).  Fat  {'■2.5  grnis.).  Milk  Sugar  ( l.)()  grnis.).  Water  (7.50  e.ein.).  Mineral 
Salts;  Protein  (.'50  grnis.).  Fat  (40  grins.).  Sugar  and  Starch  (75  grins.), 
W'ater  (1000  e.eiu.).  Mineral  Salts;  Protein  (!)()  grins.).  Fat  (4.5  grm.s.), 
Sugar  and  Starches  (400  grins.).  Water  (^2000  c.cni.).  Mineral  S.ilts. 

These  diets  represented  in  ronn<l  nuniliers  oOO,  SOO,  and  -2  K)0  calories 
respectively. 

Plate  XXW'lll  (lc|mt-.  the  central  f<-alnrc  of  tli<-  cxhihil.  The  hollies 
and  jars,  in  each  in-^t.inci'.  contained  a  ipiantit.v  of  the  food  indicated  on 
the  label,  jnst  siillicient  to  yield  a  nniforni  I-'dihI  or  Fuel  Viihie — 100 
Calories,  'ihc  three  graduated  cylinders  near  the  lower  right-hand  cor- 
ner rejiresented,  hy  colored  fluids,  the  exact  ainouiils  of  J'rotein,  Fat, 
and  ( 'arhohydrate  r<'(piired  to  yield  100  Calories,  /.  r.,  'i.j,  11,  and  •!.'>  grams. 
'J'he  foods  were  grouped  with  reference  to  the  Chief  Foodstnlf  contained, 
as  shown  hv  the  following  legends  and  shelf  lists: 


TopSlielf; 

Food,s  of  Same  Nutritive  \  ahie  in  .\mounts  Shown.  Chosen  because  of 
Richness  in  Sugars  and  Starches.  Milk  or  caiie  sugar,  rice  and  other 
cereals. 

Bottles  and  jars  containing  in  onlcr: 

Baked  Potato,  Shredded  Wheat  Biscuit.  Toast,  Soda  Cracker.s,  Sponge 
Cake,  Milk  Sugar,  Cane  Sugar.  Malt  Sugar,  Rice,  JJoiled  Rice  (same 
amount). 

Legend; 

Foods  of  Same  Nutritive  \'alue  in  .\niounts  Shown.  Chiefly  Valuable  for 
Salts  Contaiueil.  Fruits,  end  of  First  Year:  Only  those  shown  advised; 
Green  Vegetables,  end  of  Second  Year. 

Bottles  and  jars  containing  in  order: 

Orange  Juice,  Stewed  Prunes,  Apple  Sauce,  Cooked  Spinach,  Carrots, 
Asparagus. 


Lower  Shelf: 

Legend: 

Foods  of  Same  Nutritive  \  alue  in  .Vmounts  Shown.  Chosen  because  of 
Richness  in  Proteins,  such  as  albumin  or  white  of  egg,  lean  meat,  curd  of 
milk,  gluten  of  wheat  flour. 


'it' 


,:-i 


'■■•'im' 

1 

ll 

I  ||!i^ 

'ii 

3 

1 

1 

It  i* 

j-ifl        ^     1 

^^Bst 

^'      Ml 

^>          1 

>.i»Jm< 

{^^■^^^ 

pvi 

"^Si 


su 


le 


NOaansms' 


o 

C 


y. 

y, 

y. 


118 


niHFj  Tdiiv  AM)  I  AiAiAK.ri:  iir  ixiiiinrs  119 

Hollli's  :iri(l  jnrs  icinl.iiiiinj;  in  Di-drr: 

XfulVliatcl  ( 'heosc,  E^fi-  (I:irf;o).  Split  Vv:\  Souj),  V.ii'j.  Wliilc  Cow  "-  Milk. 
Skimmed  .Milk.  Buttermilk,  Iliilil.nl.  Moiled,  Wliile  Me.it  uf  Chickeu, 
Tenderloin  of  Steak,  Pressed  lleet  .Iiiii-e.  l•:^^  Water,  Ueel'  Hrotli. 

I.,-Krr„l; 
Foods  oi'  Same  Xiilritisc  \  aliie  in  AnionnI--  Shown.      ( 'lio~-en  lieraUM'  ol 
Richness  in  Fats,  --nch  as  cream.  >dlk  ol'  cl;l;.  Iiacon.  oli\c  oil. 

Hnlllrs  :n)(l  j  ir^  cmil  niiini;  m  urdi-r: 
15aeon,  Hutter,  Olive  Oil,  ^'olk  of  Fjij^s.  .\\erai;i-  (ream,  Toi)  Milk. 

The  lower  Jiart  of  I'late  XXXIX  showed  the  a|)plicat  ion  of  the  Caloric 
Method  of  eompntation  lo  human  milk  and  to  a  few  common  snhst  it  ulcs. 
l)ill'ererice>-  in  the  i-clati\c  proportion-  of  the  chief  food-tulf-  were  also 
emiiliasi/.ed. 

On  Ipprr  Shelf: 

Di.'t  of  Infant  of  id  weeks. 

Mother's  Milk,  -liowinn  (|uantity  of  each  fccdini;ari(l  numljci-  of  fced- 
inji's  US)-    total  food  \alne.  (I.")(l  calories. 

l..-rM.l: 

Modili<'d  Toj)  Milk.  Same  ('(iiii poxituni  ;is  Mothi-i-'--  .Milk-S.\MK 
FOOD  WVLIF,  (!,M)  Calorie-. 

Three  iiraduated  cylinders  eoulainiui;  coloreil  fluids  and  re|)resentini;  the 
weifjlit  of  I'rotein  (red).  Fat  (yellow  i  and  Sui^ar  (hhu')  in  a  day's  snpid.v 
of  human  milk. 

On  l,nw,-iSli,-ir: 

l-r-,-n.l: 
Incorrect  Modifications  for  10  weeks. 

Food  value, (lot)  calories.  CoiukMised  milk,  diluted  1  to  Ki:  Error — exces- 
si\e  ((uantity,  excess  of  siij^ar,  low  fat;  Correction — reduce  ((uantity,  add 
ereani.  Plain  cow's  milk,  diluted  i  j:  Error — larae  f|uantity,  lack  of  suijar. 
excess  of  ])rotein:   Correction — reduce  quantity,  ad<l  suuar  and  cream. 

Eifjht  l)ottles  containiui;  condensed  milk,  1  to  Ki;  amount  shown  in  each 
liottle  (Vi  ounces)  yields  SO  calories-   Total.  CljO  calories. 

Three  graduated  cylinders  showinu  relative  ])ro])ortions  l)y  w<'if:ht  of  ]:ro- 
tein,  fat,  milk,  and  cane  sugar  in  diluted  condensed  milk. 

Three  graduated  cylinders  showing  relative  jiroportions  hy  weight  of 
protein,  fat,  and  milk  sugai  in  diluted  cow's  milk. 


120 


DIRECTORY  .I.V/>  (  ATA/JX.rF.  OF  i:\fllllfTS  121 

Eight  holtic-^  coiitaiiiinfi'  cow's  milk  ;iii(|  wiitcr — (Minal  pjiiis:  ;mi(iiiiit 
shown  ill  cjich  Kotilf  IS  ozs.)  yiolds  SO  calorics — Total,  '!.">n  calorics. 

All  cxliiliit  showiiii;  in  concrete  form  the  ilici  of  a  Child  of  IS  Mouths  was 
also  included.      It  is  not  i>iiiiircd  in  the  I'lalcs. 

The  exhibit  shown  in  I'late  XI,  was  prepared  to  ilhistrate  a  few-  of  the 
iiian.v  forms  in  which  milk  could  !»>  ottered  to  a  child.  The  unit  of  coiii- 
])arison,  as  explained  l),v  the  IciiiMid.  was  !.")()  calorics  i list <'ad  of  1(111  calories. 

Different  l*\)inis  In  which  Milk  Ma.v  I?e  (iixcii.  ivicli  article  shown  has 
the  same  food  \alnc  as  one  iihiss  i  7 '  •_>  ounces)  of  milk,  or  l.>()  caloiies. 

Upper  Slu-lf: 

Hottlcs  conlaininu:  Cream  of  (Green")  Pea  Soup.  Cream  of  S|iiiiacli  Sou]), 
Cream  of  Lettuce  Sou]).  Cream  of  Onion  Soup.  Cream  of  .Vs])ara.uus  Soup, 
Cream  of  ( 'elerv  Soiij).  (  ream  of  ( 'orn  Soup.  (  ream  of  Potato  Soup.  (  ream 
of  Tomato  Soup,  Oyster  Stew  (straiiicd  I,  Cream.  AMicv.  Skimmed  Milk, 
Pnttcrniilk,  WIhiI.-  Slilk. 

LowiT  Stirtf: 

Six  hottles  containina':  Milk  (Irucls— Parli'.w  .\rrow  root .  Cornmcal,  Oal- 
Tucal;    Milk  Co<  oa.  and  a  Malted  Food. 

Nine  jars  conlainiiii;:  Hread  I'liddini;.  Tapioca  Piiddiiii;,  Mlaniinanuc.  IJice 
Pudilinu.  liicc  and   Macaroni  in  Milk.  Soft  Cu-lard.  Milk  Toast,  .Innkct. 

Another  exliiliil,  pot  illuslratecl.  was  meant  to  show  the  \alne  of  the 
caloric  standard  as  a  ijuidc  to  the  economical  choice  of  foods.  .\  pint  of 
milk  costiiiii'  4  cents  was  compared,  on  the  basis  of  current  prices,  with 
more  expensive  as  well  as  with  cli<'apcr  foods.  Meats,  finits.  yreen  vege- 
tables, etc..  are  examples  of  the  more  <'xpensi\c  foods:  butler,  potatoes, 
]iens.  and  cereals  of  the  less  costlw 

Cost  of  Foods.  Comparati\-c  Food  \'alues  Obtained  for  Price  of  Pint  of 
Milk  (4  cents). 

Fifteen  bottles  graduated  in  ounces.  Each  ounce  of  colored  fluid  repre- 
sented 100  calories.  The  height  of  the  fluid  in  each  bottle  measured  the 
caloric  value  of  the  food  in  question  from  the  point  of  view  of  C(JST. 


Ui        REPORT  OF  THE  PHILADELPHIA  BABY  SAVLXG  SHOW 


A  rtificinl  Feeding 

Section  U.      Booth  Xo.  30. 

Every  effort  was  made  in  this  liootli  lo  |>oint  out  the  things  that  are 
essential  to  successful  artificial  feeding.  In  the  demonstration  of  its  con- 
tents, however,  the  fact  was  emphasized  that  artificial  feeding  should 
never  be  resorted  to  until  every  effort  had  been  made  to  prove  that  the 
infant  coidd  not  be  satisfactorily  nourislied  at  tlie  mother's  breast.  Thi.s 
teaching  was  fiu'ther  imi)ressed  iiijon  tlie  visitors  l)y  the  legends  and  demon- 
strations wliich  were  given  in  the  booth  on  breast  feeding. 

The  booth  contained  the  following  charts  and  photogiaphs: 


Catecliism 

for  ^lothers — if  the  baby  must  be  bottle-led. 

Question. 

What  is  the  best  milk  to  use? 

An.swer. 

Certified  milk — Each  bottle  has  a  sjiecial  cap  with  a  Certifi- 

cate of  the  Philadelphia  Pediatric  Society. 

Q. 

What  is  Certified  Milk? 

A. 

Milk  produced  with  s|)ecial  care  so  that  it  shall  l>e  absolutely 
clean. 

Q. 

Why  tloes  it  cost  so  nuich!-' 

A. 

Because  of  the  extreme  care  and  trouble  which   is   taken  to 

uudsC  it  clean  and  wholesome. 

Q. 

Is  it  worth  all  it  costs? 

A. 

Undoulitedly.     Try  to  get  it,  if  you  can  jiossibly  afford  it. 

Q. 

Why  is  it  necessary  to  be  so  carefid  of  milk? 

A. 

Because  it  spoils  so  (|uickly  if  it  is  cx])osed  to  the  air  or  if  it  is 

not  kept  next  to  ice. 

Q. 

What  is  modified  milk? 

A. 

Milk  which  is  altered  (modified)  by  adding  water,  sugar,  etc. 

Q. 

When  should  you  u.se  modifiefl  milk? 

A. 

W  hen  told  to  do  so  by  yoiu-  DcK-tor. 

Q. 

Why  should  milk  be  modified  for  infants? 

A. 

Cow's  milk  should  always  be  diluted  with  water,  because  it  is 

too  strong.     The  younger  the  child  the  larger  the  amount  of 

water  to  be  added. 

Q. 

What  is  Pasteiu'ized  milk? 

A. 

Milk  that  is  heated  just  to  the  sinunering  point  for  30  minutes. 

It  spoils  more  easily  than  Certified  ]\Iilk. 

Q. 

\Yhat  shall  we  buy  if  we  cannot  afford  Certified  Milk? 

A. 

Buy  milk  delivered  in  bottles  by  a  clean  milkman.     If  there 

is  any  dirt  in  the  bottom  of  the  bt)ttle,  it  is  probably  manure 

and  you  had  best  change  your  milkman. 

nililA  TOHY  AM)  (  ATAlJX.Ii:  OF  I.XUIIIITS 


I--':i 


A\  lien  it   i>  iiiiii()----ililr  In  iiiirsc  yciiir  li;il)y  or  Iol'cI  ;i  wri -luirsc.  I'm.  Hahv 
slidiild  l)c  led  (III  propcrlx'  |iri'p:irfil  I'it^Ii  cou'-.  milk. 


MI'1M.I>   \\l)  liOl  ri.KS 
!?()lllcs  should   lie  round,   not    ilat.  >o  ;is  to  he  easily  cloaiiscd.      Nipples 
siionld  lie  st|-ai?ilil,  shaped  like  a  loliii  Ihimhle.  so  that   they  can  lie  turned 
inside  out  and  t  liorouiihlx' cleansed. 

.M'ter  each  Iccdini;  the  nipple  and  liiittle  should  lie  washed,  lir-t  in  cold, 
then  in  hot,  water  and  suds.  Keep  the  nipple  in  a  solution  of  lioric  ,icid 
(two  teaspoon  In  Is  to  a  cup  ot'  water  I'reshly  nun  ie  each  day  i.  Stand  the 
hot  tie  upside  do\\  n  to  drain.  Have  a  sejiarate  lioltle  I'or  each  I'eedini;.  hut 
I  he  same  nipple  uniy  lie  used  lor  all  the  leecliuu-  ol  one  (lay. 
Look  thidUi.;h  each  nipple  hefore  you  huy  it.  ^  ou  should  liarcly  ne  alile 
to  see  lii;iil  throuah  the  hole  in  the  ni])ple.  It  is  easy  to  make  a  hole  lari;er 
with  a  reil-liot  needle  point,  liut  you  cannot  make  it  suialk'r. 

It  should  take  the  lialiy  Irom  It)  to  1.")  minutes  to  empty  the  hot  t  le. 

.\  iti:i;.'rnlii  sliouiiii;  llic  ililVi'nMiii-  in  llii-  r.iti-  uf  Itnw  fiMtn  ililfi-rriil  nipplr^. 
1  niliT  cacti  iif  llii'  I'dttiiwint;  t<Kciicls  was  .-lU  ittiistralii>ii  of  ,iii  invcrli'ii  linltlc. 

a.    ]',rii  Sliiir  Xi/ijilr  h.    Midiiini  Sluir  Xi i)iili.  r.    I'lixl  Xi/iplr. 

\\  licii    Itir    liolltc    cif    milk    is  I  iiilcr    llir     same     ciUKiiliiiiis,  Mitl<   fl<i«>  from   Ilic  niiiplc   in 

liclcl    ii|i>i(li'    (liiwn,    \'i    inilic^.  Iliirr  wilt   lie  \!  m-  :>  ilroiis  lie-  a  .slciw  tint  (■(inliniKins  slrcaiii. 

aliuvi-  tin-  lalilc,  line  itrnp  wilt  I wccn  (he  nipple  and  tin-  laljt<-.  Too  fiixl. 

.strike'  tin-  lalitc  jn»t  as  I  lie  ni'\l  ./„,v^  rii/lit. 

(iiic  t<';i\ cs  liic  nipi>Ic. 
'/■„»  .-.I,,,,-. 


DIRECTIONS  Ui;(;.VRI)l.\(.  MILK  .\N1)  US  PHKl'.VK.V HON  FOR 

TIIK  15.VBV 

a.  Vou  cannot  he  too  clean,  so  do  not  lie  afraid  to  try.  The  milk,  and  the 
hottles  it  comes  in,  should  he  clean.  If  they  are  dirty,  chaniie  your  milk- 
man. The  hottles  should  not  lie  left  on  the  doorste])  for  cats  and  (lo>;s  to 
lick.  Take  them  in  as  soon  as  delivered  or  else  pro\ide  ;i  hox  with  a  cover 
for  them  to  -.land  in.  .\s  soon  as  the  milk  is  taken  in  place  it  on  the  ice. 
li.  When  the  least  hit  of  dirt  i^ets  into  milk,  the  o'erms  from  the  dirt  multiply 
so  rajiidly  thai  in  a  few  hours  the  milk  can  he  rendered  unfit  to  i;i\-e  the 
hahy.  Therefore  scald  or  lioii  everylhinf;'  which  comes  into  contact  with 
milk  and  never  leave  milk  ex])osed  to  the  air. 

c.  As  soon  as  pos^ilile  afti'r  the  milk  is  receixcil.  prciiai'c  the  feediuL;^  for  the 
entire  day. 

d.  Boil  all  uten-.ils.  including  the  nipples  and  liottli--.  for  Kl  or  \')  minutes 
hefore  i)re])ariui;'  the  uiilk  mixtures  for  the  ilay. 

e.  \Yasli  your  hands  hefore  preparing  the  lialiy"s  food. 

f.  Wash  the  neck  and  top  of  the  hottle  before  removiim  the  cap. 

g.  When  the  milk  is  jirepared.  put  the  t'eedini>s  into  the  nursiui;  hottles; 
cork  the  hottles.  and  place  then  on  ice.  I  Illustration:  Six  feeding  hottles, 
containing  milk.  ]ilaced  against  a  block  of  ii  e.j 


124        REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

A  chart  showing  the  proper  number  of  feedings  and  the  intervals  between 
them. 

1st  and  in(\ Months — Every  2  hours — 0  feedings  in  -2i  hours. 

3d,  4th,  5th      ....  "  '"       3       ••        7  

Gth,  7th,  Sth     ....  "  "       3       "        {)  " 

9th,  10th,  nth.  l'2th        .        .  "  "      4      "        5         " 

Begin  feedings  at  5  or  fi  A.  M.,  and  end  at  10  or  IIP.  M.    Night  feedings 
after  11  P.  M.  aie  unnecessary. 

DON'T  OVERLOAD  THE  BABY'S  STOMACH 

Tiie  following  life-size  pictures  of  stomachs  at  different  ages  .show  how 
small  they  are  and  how  much  they  will  hold  without  being  overstretched. 

The  Actual  Size  of  the  Stomach 


At  liirth. 

Two  weeks. 

Four  months, 

Six  months. 

Eiglit  to  ten  months 

One  oiuiee. 

Two  ounces. 

Four  ttiuiees. 

Six  ounces. 

Eight  ounces. 

BABIES  MUST  BE  GIVEN  AVATER  TO  DRINK 

Most  people  who  own  dogs  are  careful  to  give  them  plenty  of  drinking 
water,  esjiecially  during  the  hot  weather.      (Colored  drawing  of  a  dog.) 

Amateur  gardeners  never  fail  to  flood  their  thirsty  flowers  with  a  plentiful 
supply  of  fresh,  cool  water.     (Colored  drawing  of  a  pot  of  flowers.) 

The  yellow  canary  receives  a  fresh  cupful  of  water  every  morning  when 
his  feeding  cup  is  filled  with  seed.     (Colored  drawing  of  a  canary  in  a  cage.) 

MORAL ! 

Don't  forget  the  baby.  Gi\'e  clean  boiled  water  in  a  clean  bottle  with  a 
clean  nipple,  two  or  three  times  a  da.y  in  winter  and  between  feedings 
in  summer.  The  water  should  be  at  room  tem[)cratiu'e  in  winter  and 
slightly  cool,  not  ice-cold,  iu  simimer. 


FACTS  WHICH  THE  MOTHER  :\IUST  NOTE  SO  AS  TO  REPORT  TO  THE 

DOCTOR 

1.  Weight:  Whether  gain  or  loss. 

2.  Stools:  Number  and  color — Always  save  one  or  more  diapers  for  the 
doctor  to  see.     Keep  them  in  a  daily  cleaned  closed  receptacle. 

3.  Sjntting  up  or  regurgitation 

4.  \'omiting.     How  of  ten. ^ How  .soon  after  feeding? 

What  nature.^ 

5.  Gas  or  wind.     From  stomach? From  bowel? 

0.  Colic.     JNIild .severe 

7.  Does  the  baby  take  all  of  each  bottle?     How  much  does  he  leave? 

8.  Is  the  bal)y  satisfied? 

n.  Slee]3.     Day night 

10.  How  manv  hours  out-of-doors? 


Dflil-J  TdltV  WD  (  ATAlAUai:  (IF  EMU  HITS  \io 

CAITIONS  FOR  MOTHERS  AM)  M  RSES 

;i.   Kiicli  fo('<ling  should  occii])y  from  1.5  to  iJO  niiiititcs  iiud  no  loiiijcr.     If 
tlic  l);iln'  trios  to  go  to  slec])  heforc  the  l)ottI('  i-;  ciiiply,  keep  liiiii  ;i\v;ikc. 
1).  Don't  keep  what  is  left  in  the  holtic  Inr  the  next  iVcdint;-.     Throw  il 
iiway. 

c.  Milk  NJionld  !"'  diluted  aceordinix  lo  lln'  auc  heall  li  and  >\/r  of  the 
hahy.  The  doetor  should  decide  how  strong  to  make  the  food,  not  the 
next-door  neighhor. 

(1.  Feeding  too  nnich  or  loo  often  or  the  w  rong  things,  are  the  chief  causes 
of  vomiting  and  dianhea  in  infancy. 

e.  A'rvyr  i)ut  the-  uip|)le  in  your  mouth  Ix't'ore  gi\ing  it  to  llie  haliy.  I.ike- 
wis(>,  iicrcr  use  a  nipple  that  has  fallen  on  the  floor,  without  scalding  it. 
Serious  illness  is  caused  hy  such  carelessness.  It  is  much  easier  to  make 
a  l)al).v  sick  than  it  i--  to  cure  the  siekness. 

f.  ^^  hen  you  warm  an  ice-cold  hottleof  milk  just  liefore  feeding  the  hah.v, 
do  it  gradually  hy  using  lukewarm  water  first.  Otherwise,  you  may  do 
tlii^.      1  llhistralion  of  a  hroken  Ixitlle.) 

g.  Test  the  temperature  of  the  milk  hefore  gi\ing  il  to  the  liaKy.  Ky  let- 
ting a  few  drops  fall  on  the  inside  of  the  torearm.  Olheiwi>c.  nou  may 
burn  your  liahy's  mouth. 

h.   Do  not  heat  a  liottle  when  you  go  lo  Iicd  and  kec|i  it  under  the  pillow 
until  the  l)ai)y  wakes  up.      This  is  a  certain  way  to  make  the  hahx'  sick, 
i.   ^^  hen   you    lak<'    Ihc   hahy  out    during   liol    wealher,   lak(>  a    hottlc   of 
l)oilc<l  water  with  you.      Dou'l  take  a  hottlc  of  milkl 

('olorcd  (Imviiif;  sliinviiis  tin-  swolli'ii  Iri;  i)f  an  infant   snlfiTini;  from   srurri/.     Tlic 
rrsutt   of  improper  fcrdini:. 

Scurvy  rcsull>  when  nothing  Iml  caimcd  or  oxcrheatccl  foods  are  eaten 
for  a  long  time.  The  i)rolongc<i  use  of  condensed  milk  or  i)atent  foods 
made  without  fresh,  nnluvitcd  milk,  ma.v.  therefore,  cause  .scurvy. 


.\ilililioiial  tliiiii:-.  >hown  in  fiiis  Itootli  wt-rf: 

An  .r-ray  photograph  of  a  hahy's  trunk,  illustrating  the  exact  size  and 
position  of  the  .-loniach.  The  legend  underneath  it  read;  "The  dark 
ohlong  shadow  -hows  the  exact  size  and  i)osition  of  a  hah.v'-.  -.louiach." 

Two  plioto<;rapli>  illii-lrating  tlii'  proper  procnluic  in  fft-iling  the  l)aliy. 

a.  Hold  the  hahy  in  ,vour  arms  when  you  give  it  the  bottle.  Because 
the  baby  is  so  unfortunate  as  to  have  no  breast  milk  is  no  reason  why  it 
should  miss  its  mother's  arms. 

h.  If  it  is  imi)()ssible  for  the  mother  lo  hold  the  babv,  let  the  sister  hold 
the  l)ottle. 

Seven  pliotojiraplis  .sliowing  tlie  resnlts  of  gooil  and  l)a(l  artifieial  feeding. 

a.  A  baby,  age  IS  months.  Weight.  ^2.5  ])ounds — which  is  just  the  jirojjcr 
weight  for  a  child  of  this  age.  Shows  good  results  ]50ssible  from  artificial 
feeding. 

b.  A  bab.v.  aee  '2  .vears.  Weight.  '21  pounds  10  ounces.  Should  weigh  '27 
pounds.  NOTICE  the  distended  al)domen  from  continual  overfeeding. 
This  child  shows  signs  of  rickets. 


ni} 


Dllil'J  TonV  AM)  (MM.Oi.l'i:  OF  F.XllllUTS  }-27 

c.   A  l);il>y,  :ii;c  7  iiKintlis.      \\cii;lil,  II  |Hiiincl>  14  miners,  s|iiinl<l  \vciL;li   1(1 

])()im(is  S  ounces.      It  looks  fairly  hcallliy  hiil  is  never '■s.-itisticd"  liciaiiso 

it  has  heen  ini|)r<)|)eily  fed. 

(1.   A  hahy,  ai;'e  ,'5' J  nioiitlis.      W  eiiilil .  7  pnuncis  IMonnres.     Should  wciisli 

I'i  pounds  S  ounces.      It  never  receixcd  hreast   milk,  hut   was  fed  chielly 

on  proprietary  foods.      It  has  gained  one  pound  in  two  \v<-eks  on  a  pioper 

milk  mixture. 

V.   .V  l)al),N',  at;('  7  months  :>  weeks.      Wei^lil,   1  1  pounds  (i  ounces.      Should 

weifi'ii  17  jiounds.     The  piclure  shows  a  lar^e  helly  and  v\cak  muscles  and 

poor  imtrition. 

f.    .V    ('liiuese   hahy,   aiiC  .J    monlhs.      \\eiL;lil,    Id   pounds   1(1  ounces.      \\ 

liirlh  .")  pounds  !•  ounces.      Shows  lirm  umscles      |)l<>nl  y  of  fa  I       norm.al  de- 

velopmenl.      Stomaeii  distended  after  a  I'eediTii;. 

t;.   .\  liai>.v,  ai;e  !■' 2  inouths.      Weight,  7  pounds  7  ounces.      Should  wei^h 

\i   pounds.      Was   iinj)roperl,\'   fed    until    IS   days   hefore   Ihe   |iiclurc    was 

taken;   uained   l.">  ounces  in  IS  da.vs  on  a  ]U'o(ier  milk  mixlnre. 

Shelf   coutaiiiinii;     Weitxlit     scales,    proper-     feeding;     hollies,    nijiplcs    and 

hruslies  for  eleaninsi  Itotlles. 

Card-hoard  clock  dial  with  movable  iuuids  for  indicaliui,'  Ihe  hour  of   Ihe 

next  leedinu'.      Thermometers  for    teslinij;   Ihe    tenipeialure   of    milk    pi'e- 

parc(|  for  fecdini;. 

Sfclioiil).      lidnlli  N(i.  :!'.2.     ^S^■(■  IMalfXM.l 

A    I'l.MN    K  ITCH  I.N 

This  lioolh  n'pi-esenled  a  simi)ie  kitchen  such  as  could  he  inshdled  in  any 
home.  The  lloor  was  covered  with  oil  (lolli,  and  Ihe  e(|uipnienl  con- 
sisted of: 

1.   .\  plain  kitchen  lalile  in  its  i cuter. 

i2.   A  smaller  kitchen  lahle  in  the  rear  upon  which  were  placed  some  cook- 
ing utensils. 

3.  A.'losel. 

4.  Two  sheK'es. 

5.  A  cheap  ice-hox. 
().   .V  waste  call. 

7.  A  eliair. 

8.  A  sink  ihot  and  i-old  water)  and  drain  hoard. 
!).  A  <;as  stove. 

1(1.  ( 'ooking'  utensils. 

11.  All  necessary  utensil.s  for  cleaning'  and  sterilizing  hottles. 

1^2.  A  fly -catcher. 

13.  Jars  for  sugar,  cereals  and  other  ingredients  of  milk  mixtures. 

A  qualified  registered  nurse  was  in  constant  attendance  in  this  hooth. 
Every  half-hour  during  the  day  she  gave  demonstrations  in  the  care  of 
milk  in  the  home,  the  ijreparation  of  milk  mixtures,  the  ])asteurization 
of  milk,  and  the  cleansing  and  preservation  of  bottles,  nijjples  and  other 
utensils. 


128 


ninij  TORY  AM)  <  ATM.iu.n:  or  i:\niiiiTs  u<) 


Breast  Fccrliuff 

|S,-,-  I'hil.-  Xl.lll 
Section  I).      Bi.iillis  N'ds.  ;U  ami  :!(). 

Much  time  anil  can- were  cxiw-nded  in  ('iidcavDriiii;  l<i  ma!<('  tlicsc  hoollis 
particularly  allractixc,  in  order  tr)  coiiecMitrate  the  at  tt'iitioii  of  all  those 
who  visited  the  Show  not  only  upon  the  artistie  illustrations,  hut  also  u])on 
the  inipoitant  teachintis  whieh  were  contained  in  the  i)rinle(l  charts. 
Most  of  the  educational  leijends  in  these  hooths  were  show  n  on  an  adver- 
grajili. 

These  hoot  lis  were  under  the  const  a  nl  direction  ol'  an  at  tractive,  intelli^'cul 
antl  interested  trained  nurse  in  uniform,  who,  in  addition  to  answeiiui:  any 
(pieslious  that  were  asked  of  her,  distril)ulcd  colored  litlioi:rai)lis  of  an 
orijiinal  water-color  i)aintinf;',  entitled.  "  Mother  and  Nursini;  Child."  Iiy 
Eleanore  AhhotI  (sec  Plate  XLIII),  which  painlini;  was  huui;  in  thcci'nier 
of  the  main  liootli. 

In  addition  lo  the  water-color  painting;  referrccl  to.  Ihc  hooth  contained 
two  pictures  liy  (iari  Melchers  one  entitled  "Mother  and  (liild.  '  and 
the  other,  "  Mother  Nursing  a  IJalic  ';  a  i)as  rcliit.  l>y  Louis  H.  l)oUi,dierty, 
entitled  "IJIiss,"  which  represented  an  infant  at  the  breast;  a  ])hotourapli 
of  a  mother  nursiufj  her  hah.v,  entitled,  "'I'he  'I'rue  ("ons(>rvalion  of  Infant 
Life";  a  photograph  of  a  hahy  on  a  pair  of  wciuhinji;  scales,  over  which  was 
written  the  advice,  "Weigh, vour  hahy  often."  and  underneath  which  was 
the  legend,  "  Hreast-fed;  seven  and  a  half  months  old;  weighs  17'  o  pt)unds, 
anil  is  al)le  to  sit  uj)  alone";  a  i)hotogra|)h  of  a  mother  with  a  |)rotective 
covering  over  the  nose  and  mouth,  and  an  infant  at  her  breast,  underneath 
whieh  was  written  the  legend,  "This  is  the  wa,v  to  avoid  giving  .vour  infant 
your  eokl";  a  i)en  and  ink  sketch  of  a  bab.v  and  a  ealf,  the  ealf  looking  at 
the  baby,  and  the  calf  being  made  to  sa,v:  "You  are  the  fellow  who  has  been 
stealing  m,v  breakfast  and  supi)er.     Where  is  vour  own  mother?" 

The  following  legends  and  advice  aj)peareil  on  the  charts  which  were 
hiuit;  in  these  booths: 


Take  this  child  awa,v.  and  nur^c  it  for  mc.  and  I  will  give  thee  th,v  wages. 
And  the  woman  took  the  child  and  nursed  it.     And  the  child  grew. 

Exodus,  Chap.  J,  9th  and  10th  verses. 


To  the  mother's  nature  has  been  assigned  the  continued  duty.  res|)onsibil- 
ity,  and  sujireme  jo,v  of  the  jiersonal  nourishment  and  care  of  her  offspring, 
and  nothing  can  riglitl.v  replace  it. 


130 


REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 


You  cannot  raise  a  race  of  sturdy  men  and  women  on  the  bottle.  If  a 
nation  is  to  possess  vigor,  it  must  in-o\ide  mothers  in  fact  as  well  as  ni 
name — mothers  wlio  nourish  their  offspring  at  their  breasts. 


THE  REL.\TIVE  EXPENSE  OF  BREAST  AND  BOTTLE  FEEDING 


Breast  Feeding. 


Bottle  Feeding. 


Bottles 

Nipples 

Milk 

Lime-water 

Sugar  of  milk 

Barlev 

Ice 

Bottle-l)riishes 

Soda 

Physician 

Medicine 

These  are  necessary  to  the  health  of  the  nursing  mother: 

Fresh  Air  ** 

Projier  Rest 

Moderate  exercise  out-of-doors 

Daily  warm  bath 

Loose  clothing 

Clcaidiness  of  breasts  and  nijiples 

A  nursing  mother  should  drink  jdenty  of  water  and  eat  three  good  meals  a  day. 
Select  from  these: 


Breakfast 

Fruits 

Cereals 

Eggs 

Bacon 

Fish 

Rolls 

Toast 

Potatoes 

Cocoa 

Coffee 

Milk 


Luncheon 

Broth 

Cold  Meat 

(^hops 

Fish 

Oysters 

Potatoes 

]?read 

Pudding 

Jelly 

Stewed  fruit 

Cocoa 

Milk 


Dinner 
Sou]) 
Chicken 
Roast  beef 
Roast  lamb 
Beef-steak 
Fish 

Potatoes 
Green  vegetables 
Pudding 
Custard 
Ice-cream 
Milk 


Breast  milk  may  be  changed  so  as  to  make  it  harmful  to  the  l)aby  by  any 
of  the  following: 


Fits  of  temper 
Unwillingness  to  nurse 
Unhapijiness 


Hurry 
Worry 
Irregularity  in  rest  and  habits 


DiHFJ  Tonv  .i.\i>  (  ATMju.ri:  or  kxiiiiuts  vm 

AVhy  tlic  milk  of  sonic  mothers  is  bad  for  the  l-'al>y. 

Uecaiise  they — 

Xurse  the  lialiy   lonj/jer  than  'SO  minutes 

whenever  it  cries. 

irre<;uhirly. 
Drink  tea. 

porter  and  licer. 
Do  nol  (hink  enough  water. 

Don"!   nurse  the  hahy  c\cry  lime  it   cries.      Irreguhir   luirsing  or   nursinij 
too  often  spoils  llic  mothers  milk  and  the  l)al)y"s  sloniacli. 

Nur--inu  llic  KaKy  ,il   iiii;lil  may  so  exhaust  the  milk  supply  as  to  render  il 
insuflicicnt  for  the  day  leedinys. 

(Iiarl  --liowinL;  feeding;  hoins  at  <litfci'cnt   periods  diirilii;  the  lirst  year: 

First  and  Second  Months:    excry  two  hours,  no  iiiiiht    feedings.      (Illus- 
trative Diagram. : 

Thinl  to  Ninth   .Mouths:    cxcry  three   hours,   no   night    feedings.      (Ilhis- 
tratix  e  Diagram.) 

Xinih  to  Twelfth   Months:    e\-ery  four  liourN.  no  night    feedings.      (Ilhis- 
trative  Diagram.) 

Tlie  lialiy  may  cry  heeause  il  i^  hiingr\',  hut  it  is  usu.illy  liccause  of: 

Discomfort 

Indigestion 

Pain 

Habit 

Temper 

Schedule  of  weight  and  length  of  Ijody  according  to  age — covering  the 
hrst  two  years: 

-If/p  Weight  Length 

Birth 7^3  pounds  H)  inches 

One  month 8^4 

Two  nu)nths \0]/^ 

Three      "   1-2}|       "  i-lYi  " 

Four        "   14 

Five        ••   141., 

Six  •'   15  ■•  '26 

Seven      "   Iti 

Eight      ••   17 

Nine       "   18  "  27i  •>  " 

Ten         " HI 

Eleven    "   \J0 

Twelve   '•   -21  "  30 

Two  years '28  "  333  2  " 

10 


I'l.AIE  XLllI 

REPRODUCTION    FROM    A    COLORED    LITHOGRAPH    MADE    FROM    AN    ORIGINAL   WATER- 
COLOR  PAINTING:  "MOTHER  AND  NURSING  CHILD"— ELEANORE  ABBOTT 
Tlie  lithograph,  with  "Rules  for  the  Nursing  Mother"  printed  on  the  reverse  side,  was  freely  distributed  to 

women 
(See  Reverse  Side) 


):!'2 


Baby   Saving  Sho^w 


PHILADELPHIA,  1912 


Rules  for  the  Nursing  Mother 

F<>K  two  or  three  months  hetore  the  bah}"  is  lioru  the  clothing  should  be  worn  loosely  over  the 
breasts.     The  nipples  slio\ild  be  waslied  each  day  with  clean  water  and  (jently  drawn  out  with 
thumb  and  foretiiv^ier  and  smeared  with  cocoa  butter,  cold  cream,  or  sweet  oil.     This  may 
pre\ent  sor.e  and  depressed  nip])Ies. 

In  oriler  to  nurse  the  baby  successfully  the  mother  should  lead  a  lite  free  from  worry  and 
excitement.  She  should  eat  three  j;ood  meals  a  day  of  nourisbin',;  food.  She  sliould  drink  water 
freeb",  at  least  t\\'o  (2)  (piarts  a  day.  The  nursinix  mother  should  not  drink  tea.  cofTee,  beer,  or  other 
alcoholic  drinks.  The  bowels  nuist  be  open  once  a  d.ay.  The  mother  should  have  plenty  of  sunliuht 
and  fresh  air,  and  have  at  least  ei^ht  lunirs  sleei>  at  nii;ht. 

The  baby  should  be  put  to  the  breast  every  four  hours  after  it  is  born  until  the  milk  comes 
on  the  tliird  day.  Do  not  <:ive  su^ar  water,  gruels,  catnip  tea,  or  canionnle  tea  durini;  this  period. 
Gi\e  the  baby  a  little  warm  water  from  a  teaspoon. 

NURSE  THE  BABY  REGULARLY 

I-"or  the  first  two  months,  nurse  every  2  hours  from  ,^  or  6  .\.  M.  until  10  or  11  P.  M. 

From  three  to  four  months,  nurse  c\ery  2':  hours    " 

From   four  to  nine  months,  nurse  e\'ery  5  hours    "  "         "  "  " 

From  nine  to  twebe  months,  nurse  every  4  hours. 

Feedings  between  11  P.  M.  and  5  A.  M.  are  ininecessary.  Ne\er  nurse  the  baby  sinij)ly 
bec.iuse  it  cries.      If  the  cryintj  is  due  to  indigestion,  nursing  will  onl}'  make  the  bab\'spain  \\"orse. 

Don't  forget  to  i;i\e  the  breast-fed  infant  water  to  drink. 

.After  nursini;,  wash  off  the  nip|)les  with  boric  acid  water  (one  teaspoonful  of  boric  acid  to  a 
tsacupful  of  warm  water)  and  then  dry  them  carefully.  Wash  the  nipples  a^ain  with  clean  water 
before  niirsint^.  If  the  nipples  become  sore,  use  a  nipple  shield  luitil  you  can  see  \"our  doctfft.  If 
there  is  too  much  milk,  [lut  on  a  breast  binder  and  if  necessary  xise  a  breast  i>ump. 

The  best  way  to  ba\"e  good  breast  milk  is  to  nurse  the  baby  regularly  by  the  clock,  and  drink 
freel)'  of  water  (t\\(>  <iuarts  of  water  a  da\").  YelKjw  cornmeal  i^ruel  will  often  increase  the  breast 
milk  (two  tablespoonfuls  of  yellow  cornmeal  to  the  quart  of  water,  boil  in  a  covered  vessel  for  5  hours). 
A  quart  of  milk  should  be  taken  daily.  Cocoa  made  with  milk  is  very  good.  Do  not  wean  the  baby 
on  your  own  responsibility,  or  for  slight  causes.  For  instance,  green  stools  are  no  indication  to  wean 
the  baby.     Alwa\ s  consult  your  doctor  before  taking  the  baby  off  the  breast. 

The  babv  should  gain  at  least  4  ounces  a  week. 

Even  if  the  milk  is  scanty  at  first,  and  tlie  baby  does  not  seem  to  be  gaining  in  weight  rapidly, 
attention  t(j  these  rides  w  ill  often  bring  about  a  good  suppl}'  of  milk  and  enable  the  baby  to  be  nursed 
until  it  is  safe  to  give  it  the  bottle. 

If  the  mother  has  not  enough  milk  for  all  the  feedings,  two  or  three  breast  feedings  a  day 
may  save  the  baby's  life. 

See  your  Doctor : 

If  the  nipples  are  sc)re  or  cracked. 

If  the  milk  is  scanty. 

If  the  breasts  are  caked. 

If  the  baby  does  not  gain  in  weight. 

(Reverse  side.) 


133 


13J,        REPORT  OF  THE  PHILADELPHIA  BABY  SAVIXG  SHOW 

Section  D.     Booth  No.  40. 


Every  huhy  is  entitled  to  its  natural  food,  breast  milk. 

Any  other  food  than  breast  milk  is  unnatural. 

Many  thousands  of  babies  die  every  year  of  marasmus,  because  there 
is  no  breast  milk  tor  them. 

Marasmus  results  from  their  inability  to  digest  and  assimilate  cow's 
milk.     Therefore  they  starve  even  in  the  midst  of  plenty. 

It  is  our  duty  to  do  everything  in  our  power  to  secure  breast  milk  for 
babies.     It  is  their  birthright  and,  in  many  cases,  their  only  chance  for  life. 

Putting  a  baby  on  the  bottle  is  a  serious  matter,  never  to  be  undertaken 
lightly. 

We  should  never  consent  to  begin  bottle  feeding  until  we  have  exhausted 
every  means  to  secure  breast  milk. 

The  exhibition  of  the  various  rules  and  appliances  for  bottle  feeding  is 
for  the  l)enefit  of  those  unfortunate  baliies  who  have  been  denied  their 
birthright,  but  whom  we  just  do  our  best  to  save. 


Projjhylaxis  of  Breasts. 

Before  Birth. 

Gently  wash  the  nip])les  daily  with  a  mixture  of  equal  parts  alcohol 
and  water.     Anoint  with  cold  cream. 

After  Birth. 

Wash  the  nipples  before  and  after  nursing  with  a  solution  of  boric 
acid. 

If  the  breasts  are  too  full,  use  a  breast  pump,  and,  if  necessary,  a  breast 
binder. 

If  the  nijijiles  are  sore  or  cracked,  or  if  the  breasts  become  caked,  consult 
your  doctor. 

Don't  treat  them  with  any  old  thing  that  your  neighbor  advises. 

Cartoon: 

The  Perils  of  Babyhood.  A  baby  seated  in  a  basin  floating  on  water 
and  surrounded  by  protruding  rocks — the  rocks  indicating  jjatent  foods, 
etc. 


Only  one  in  ten  bottle-fed  baliies  is  well  developed  and  the  bad  results  of 
bottle-feeding  sometimes  last  a  lifetime.  Poor  develojiment  of  adults  often 
owes  its  origin  to  the  fact  that  their  mothei's  could  not  or  would  not  nurse 
them. 


DiniJ  roll)'  AM)  (  ATAUU.l'K  OF  KXIIIHITS  135 

C'arefullv  note  these  facts: 


Every  attempt  to  depart  from  I)reast-f(>e(lintf  adds  to  llie  mimlier  of  d<'allis 
amoiit;  hahies.  'Jlie  hreast-fed  l)al)y  lias  ten  times  as  many  eliaiices  of  li\  - 
ing  as  a  hottle-fed  hahy. 

Bottle-I'eil  lial)ies  are  ten  limes  more  lialile  to  Ljel  diarrhea  llian  hreast- 
fed  l)al)ies.  Only  one  l)reast-red  l)ali\'  wil  h  (harriiea  will  die.  to  7((  hottle- 
fed  hahies  with  the  same  disease. 

Tlie  hest  way  to  inerea'-e  tlie  How  of  hrea->t  milk  is  to  nni-^-e  the  hahy 
regnlai'ly. 

Very  mneh  can  he  ilone  l)y  proper  food.  pro|)er  ii\ing  and  |>ro|)i'r  care  of 
the  hreasts.  to  help  t  he  mother  nnrse  her  hahy. 


"(ii\<'  ns  iiood  motherhood  and  jzood  prenatal  <-onditions,  and  I  have  no 
des]>air  for  the  fntnre  of  this  or  any  other  country."-    John  lUinix. 


There  \\<'re  al>o  show  n  in  t  lic-e  hoot  li<  : 

1.  'J'wo  ])liials  eontainiui;  partly  diirested  mother's  milk,  side  hy  side  with 

two  i)liials  of  partly  digested  cow's  milk,  shown  for  the  purpose  of 
empha-'i/im;  the  ditfer<'lic<'  in  the  size  of  the  curcU. 

2.  Five  life-size  glass  models  of  stomachs,  re])resenting  the  size  at  l)irth, 

at  two  weeks,  at  two  months,  at  six  months,  at  eight  months;    an 
aceom|)anying  legend  em])hasized  the  small  size  of  a  l)al)y's  stomach. 

•S.  .\  shelt  holding  seven  hell-jars  containing  sanii)le  meals  (hreakfast, 
diimer  and  sup|)eri  for  luirsing  mothers;  accompanied  hy  an  ex])lana- 
tory  note  relating  to  the  jirojier  kinds  and  amounts  of  t'oods. 

4.  A  sam])le  hreast-hinder. 

J.  \n  advergraph.  This  was  an  electrically  operated  instrument  that  di  — 
])laye(l  successively  seventeen  educational  legends  relating  to  hrea>t 
i'eetling. 

A  MODEL  OF  A  HOOM  FITTED  (P  FOR  THE  USE  OF  A  BABY  DURING 

TIIK  nor  WEATHER 

An  attempt  was  madi'  in  this  room  to  sliow  how  it  is  jiossihle  to  utilize 
the  average  sleeping  room  in  the  smaller  houses  to  the  Ix'st  advantage  for  an 
infant  during  the  summer  months.  The  window-sashes  of  the  room  had 
heen  removed  in  order  to  admit  as  much  air  as  ])ossihle,  and  the  outer 
]iortion  of  the  window-frame  was  covered  with  mos(iuito  netting.  An  awn- 
ing hung  heforc  the  window,  for  the  ijurpose  of  keeping  out  the  rain  and 
protecting  the  infant  against  the  direct  rays  of  the  sun.  The  floor  of  the 
room  was  uncovered,  and  the  room  contained  an  infant's  erih,  u])on  which 


136 


DIRECTORY  AM)  (  ATALiX.ll-:  OF  EMIIRI  Is  137 

AMIS  |ihi<i'(l  ;i  lart^c  dull  (re])iTsoiiliiiu  an  iiifaiil  wliidi  was  very  lightly  clad; 
a  lly-killcr;   a  chair;   and  a  ci)\-ci'C(i  jiail  tor  -nilcd  dia|)cr-. 

Hy  means  of  placards,  attention  was  directed  to  the  iniportaTice  of  placini; 
milk  on  ice  immediately  after  it  has  l,oen  delivered;  of  killitiir  any  Hies 
w  liicli  niiiiht  he  in  the  room;  and  of  rcniov  iic  the  soiled  diapers  and  plaeinu' 
them  in  a  covered  vessel. 


Care  of  the  Hohii 

The  exhihits  in  the  hoot  lis  relating;  to  the  cai'e  of  the  hahy,  as  w  ill  he  s(>en  from 
a  s|ud.\'  of  the  |)liotot;raphie  |>lat<'s.  were  larL;<'l.\  compos<'d  of  models.  There  wer<\ 
li(i\\c\cr,  a  nnmlier  <pf  charts  and  photoi;raphs.  A  detailc<l  description  ol  the 
contents  of  IJic  lionths  follows: 


Scilicml).      lin.illi  N..,J7.     (Sro  Plate- Xl.IV.) 

In  the  center  of  this  hooth  were  hnnt;  fixe  pholoyraplis  ilhistralini;  the  proper 
proeeclnre  to  follow  in  dressing  a  Itah.v.  Innne(lialel.\-  above  them  was  liiuifi  ;i 
lei^'end  readint;: 

"How    to   dress    th<'   hahy." 

On  a  shelf  heneath  the  ])hoto.t:raphs  were  sc\<'n  dolU,  ilhisl  rat  inii  the  methods 
of  ap|)lyini;  articles  of  elothini;'  and  the  manner  of  dot  hini;  an  infant  on  hot  and  cold 
days. 

( )n  the  \arious  walls  of  the  hootlis  were  hnnt;  pattci-ns  and  com|)lctc  onlfits 
of  elothini;  of  ditferent  (lualities,  one  of  them  heini;  Tnade  from  adnlt  clolhini;,  in- 
tended to  illnslrate  an  economical  method  of  ])rovidini;'  an  outfit  for  an  infant. 

Ilnm;'  npon  the  wall,  and  placed  npoii  the  shelf,  weri'  a  nnmlicr  of  [ilain  wooden 
to.v.s,  and  above  them  \\\\\\\<,  the  legend: 

"The  l)aby  cannot  lick  paint  from  these." 

Section  D.     H.iolli  Xo. '2!).     (Six- Plate  XLV.  1 

This  b<ioth  contained  the  followinu  articles  needed  in  the  bathini;  of  thi-  baby: 

.V  small  tin  tub;  a  large  dish-pan;  a  soap  tlish  containing  (astili-  soap;  ;i 
small  clotlies-i'ac-k.  npon  which  were  hung  the  neees.sary  towels  and  a  sanitary  w.ish- 
clotli;  a  chair;  a  small  tal>le  n])on  which  was  ])laced  a  tra.v  containing  baby  dust- 
ing-l)OW<ler,  a  small  bottle  of  oli\e  oil.  a  box  of  zinc  ointment,  some  pledgets  of 
sterile  cotton,  and  a  bottle  of  boiled  water.  \\y  the  bath-tub  there  was  a  naked 
doll,  representing  a  baby  ready  for  tlie  bath.  There  was  also  a  weighing  scales, 
upon  which  was  placed  a  doll  baby.  .Vboxc  the  latter  was  hung  a  h-genil  which 
read : 

"Have  your  baby  weighed  ex'ery  month  at  the  butcliers  or  grocers.     The 
babv  should  aain  \i  ounces  each  month." 


138 


DIRECTniiY  WD  (AT. [/.<)(, 11-:  ()/■'  i:.\  I/I  HITS  ]'M 

Oil  llic  walls  (if  llic  iiDotli  was  limit:  a  <liaii   coiil  ailiilii:  lli<-  lnllciw  iiii;  l<'i;(  ii<l: 

"  IJahy's  daily  lialli.      Madi  liali\'  slidiild  li.-i\c  ils  own  soap,  wash-dolli. 
and   towel.      .Vl'tcr  each   Kalli   scald  oiil   the  tiili  and    lioil    llic  towels  and 

w  ash  elolli." 

In  the  renter  of  the  lioolli  uas  ;i  l;iroc  eliart  eoiilainini;  two  pliotograjjlis.  side 
l)y  side  -one  of  a  eniiii:  liali\  ainl  the  other  of  a  -niilint;  liahy.  Beneath  were  the 
leL'ends: 


This  luiliji  Is  Cross.      Win/? 

He  i.s  fed  or  taken   ii|)   \\liene\e 

r  h.- 

crie.s. 

He  is  fed  loo  mneli. 

He  gets  iee-ereani  or  eaiidy. 

He  i.s  dressed  too  warmly. 

He  needs  a  hath. 

His  liowels  do  not  mo\  e  right. 

He  is  wet. 

He  is  kepi   np  too  late. 

He  sleeps  in  a  hot  room  with  \\  im 

ows 

shut. 

He  is  earned,  rocked  or  Komiccd. 

He  is  taken  to  the  "'inoNies." 

He  is  given  a  comtorter  or  soot 

ling 

syrup. 

Tins  Hdhi/  Is  lluppii.      U'ln/'f' 
lie  is  fed  regularly. 
lie  i^  fed  propi-rl\'. 
He  gels  lioilcd  ualer  lo  drink. 
He  IS  dressed  properly. 
lie  is  hat  Ik'iI  e\cry  day. 
Hi-,  houcls  mo\('  e\('ry  day. 
1  le  i~  ke[)l  dry  and  clean. 
lie  has  plenix'  of  sleep. 
He  has  fresh  air  all  t  he  time. 
He  is  lei  alon<'. 

'J"iii;hk  .\uk  no  I'"i.ii;s  on  1Ii\i. 
He  gels  no  patent   medicine. 


There  were,  in  addition,  three  |iliotograplis.  one  illiislraling  the  nielhod  of 
cleansing  the  eyes  of  a  hahy.  aii<i  the  other  two  illii^t  rating  the  proper  method  of 
bathing  the  baby. 

Section  P.     T?nntli  Xu.  31, 

This  booth  contained  a  swinging  bed  made  out  of  cord  so  woNeii  as  to  allow 
the  air  lo  penetrate.  This  was  covered  with  mosfpiito  netting.  JJeside  it  was  an 
ordinary  clothes-basket,  wiiieii  was  fitted  up  with  a  bhmket,  comfort,  and  pillow, 
and  abo\e  it  was  a  sign  reading: 

".Vnotlier  jilace  for  the  baby   lo  sleej). "' 

There  was  also  an  iron  crib  for  the  use  of  tiic  infant  when  it  had  outgrown  the 
former  de\'ice,  and  pro\-iding  more  room  for  it  to  roll  and  kick.  Al)ove  thi.s  was  a 
sign  which  read: 

"To  l)e  strong  and  healthy  the  baby  must  kick  its  legs  and  move  its  arms 

freely  every  day.     To  do  this,  place  him  on  a  bed  in  a  warm  room,  with  all 

his  clothing  remo^•ed  but  the  shirt  and  diaper." 


140 


DIRI'J  TOHV  .l\J)  (  ATAlJn.i  E  OF  i:.\I/llilTS  Ul 

I  pipii  tlic  w.ills  of  tile  lioiitli  wcri'  llic  foHdwiiia'  lea'ciids; 

■■'I'lif  l)al>y  iiHist  not  sleep  in  tlie  .saiiu>  lied  witli  liis  iiiollier." 
'■  l''or  tile  first  six  months  tlio  l)al)y  slionld  sleep  eiiihteen  lionrs  each  <lay. 
I'l'oni  the  aije  of  six  nionlhs  In  one  \<'ar.  he  shonlil  sleep  fifteen  hours  each 

day. 
l"'roiii  liieafjcof  one  year   to   Iwci  years,  lie   slmnld  sli-ep    fourteen    hours 

each  day." 

IJeneath  tills  leijend  was  a  irraphie  eliart  eontainini;  a  eirele  wliieli  was  marked 
oil'  into  \arioiis  seymeiits  in  hlaek  and  white,  the  lilaek  indieatini;  the  hours  for 
sleep  and  the  white  the  hours  for  wakiui;,  teedin;:,  and  lialhitii;. 

Other  lej^ciids  on  I  he  walls  read: 

"I'ul  ,\<)nr  liali,\'  to  lied  at  (i  o'clock.      Kee|)  the  windows  in  Ihe  lied-room 

ojieu  all  nii^ht .  " 

■'If  t  he  Kaliy's  hands  and  feet  are  cold,  iise  liot-w  ater  hot  t  les." 

"The  liali.v  III  list  lireathe  fresh  air  da>'  and  iiii;lil .  " 

"  Keej)  the  hahy  warm  hy  the  use  of  sufficient  liody-  and  lie<l-clollies.    The 
hed-elolhes  must  not  l)e  damp,  and  the  lied  must  he  aired  e\('ry  day." 

Two  diapers  were  iiuni;  on  the  wall  of  Ihe  lioolli,  one  folded  prolierly  and  the 
oilier  hani;in^  loos<>;    lieiieath  liieni  appeared  the  followiii;.;  leiicnds: 

"  Keep  Ihe  dirty  diapt'rs  in  water  in  a  co\-ered  hiiekel  until  ready  to  wash. 

Wash  them  as  soon  as  possihle,  and  after  wasliiuu,  hoil  them.      Dry  them 

well.      Keep  them  in  a  clean  place." 

"Alwiiys  keep  a  clean  diaper  on  the  lialiy." 

Special  oiu])hasis  was  laid  upon  the  (pialily  of  material  from  which  dia|)crs 
should  he  made,  and  the  ])r()])er  sort  of  dia|)er  cloth  was  shown.  IJeneath  this  was 
tile  leyend: 

"Diap<'rs  made  from  tln'se  materials  oiiLjht  not  to  irritate  the  halix's  skin, 
because  they  are  soft.       They  are  also  easily  washed." 

Seotic.n  I).      ll.K.lh  Xo.  ;{;!.      ( S>v  I'lalr  Xl.VI. 

This  booth  coutaineil  a  ereei)in<;'  pen,  jilaced  on  a  platform  ele\ate(l  alio\e  the 
floor.  Tiie  liottoni  of  the  i)en  was  coxered  with  waddin",  upon  which  was  plaeetl  a 
doll  with  a  number  of  toys.  Beside  it  was  a  baby  carriage  of  projjer  design  and  ;i 
eonimode  chair. 

In  the  center  of  tlie  liooth  was  a  legend  reading: 

"IIow  should  tile  baby  be  |  ickcil  iij)  and  held)'      Place  one  hand  under  his 
back,  the  other  under  his  head  and  neck.      Ahvavs  supixirf  his  head  and 

back." 

Beneath  it  was  a  chart  reading: 

"The  baby  must  not  sit  upright  b<'fore  he  is  eight  months  old.      Ilis  back 
is  not  strong  enough.      It  might  get  crooked." 


U2 


DIRECTORY  AM)  (  ATALoi.l'i:  OF  KXlIiniTS  u,'! 

Adililicinal  Ic^'ciiils  read : 

"I'laco  the  hahy  oiit-of-doors  tii  ^Iccp  caili  day:    lie  need-  t'rc-li  air." 
"A  clean  house,  a  elean  floor,  and  a  clean  liaUy  lielp  to  l<ee|)  tlie  l>aii>-  well." 
■■  Keep  the  floor  clean  so  that  the  l)al)y  will  not  eat  dirt." 
"  Do  not  spit  (in  I  he  floor." 

I  here  were  several  photoiil'aphs  and  colored  pictures  of  lial)ies  ujion  the  walls 
of  I  he  III  lot  li. 

COMMITTKK  ()\   (  inM)II(!()l)  IIKAI.TII   KXIIIlUr  OF   KOSION 
|l?()()ins  Nos.  ■:,:,  .\M)  :i7] 

Swtiiml).      H.Milh  \.i.  ;!.3.      iSrc  I'lal,- Xl.\  II.) 

This  liooth  was  devoted   almost   e\clusi\-ely  toweariui;   apparel   for  the  lialiy 
and  eontaincil : 

.V  pattern  ol  a  sh'c]  ini;  coat  for  the  iialiv,  cost  ini;  ten  c<'nls;  coat  of  i;ray 
flannel  lined  with  pink  eiderdown  made  uj)  fiom  this  pattern  [this 
coat  eoNcred  the  hahy's  arms,  feet,  and  l)od.\-,  and  an  attached  hood  for 
its  head,  left  onlv  the  face  visihle.  The  ap|)ro\iniale  cost  was  shown 
to  lie  liul  •'^f.lO];  shoes  for  children  of  different  ajies  the  |)rice  on  each 
pail-;  driers  for  stockings  and  shirt — costini;-  thirty-five  and  lifl.v  cents,  re- 
speclivcly;  an  ordinarv  elothes-haskel  made  uj)  as  a  hahy's  hed.  with 
nialtress  co\-ered  with  ruhher  sheet,  hlankets.  etc..  and  a  eheai)  hammock 
made  of  cainas.  with  a  nios(|uilo  neltinu  co\-eiini;.  which  could  he  Ininij 
an.\where. 

Section  I),      iiiiiilli    \...  .iT.      iSir  I'lalr  \I.\  III. 

This  hooth  contained  samples  nf  chililren's  clutiilni;,  rompci-s.  dresses, 
undershirts,  complete  outfits  of  clolhinn  for  lln'  newhorn — of  ".i  grades — 
and  patterns  antl  cut  mati'rials  for  the  making  of  outflts.  'I'he  price  was 
attached  to  each  article  of  elotliing  and  to  each  complete  outfit. 
The  outfits  contained  all  n<'cessar\'  articles  and  were  forniul.ileil  with  a 
view  to  securing  the  l)est  value  at  the  lowest  ])ossihle  jjrice. 

There  were  also  shown  an  Ice-hox.  a  Chai)in  (iii)])er.  liottles.  nipples,  a 
funnel,  a  graduated  glass.  (Sign  over  ice-hox  reading:  Home-made  I<-e- 
box,  cost  31  cents,  and  nine  jihotographs  illustrating  the  method  of  mak- 
ing the  ice-box.) 

The  Committee  on  Childhood  Ile.illh  Kxliihit  jihu-es  these  sample  .irl  ides 
on  exhibition,  in  charge  of  a  skilled  demonstrator  in  a  room  in  the 
thickly  iiopulatetl  districts  of  Boston,  wliere  they  can  be  inspected  b.v 
prospective  mothers  and  where  these  mothers  can  secure  coupons  to  one 
of  several  of  the  large  tlepartnient  stores  of  Boston,  from  which  they  can 
purchase  these  outfits  comi)lete  at  the  price  (luoted  by  the  Committee. 


H 
c/j 

O 

o 


J 


u-t 


niHFJTOUY  AM)  (  ATMJX.f'K  OF  KXUllilTS  U.l 


Bad  Booth 
riii.\(.s  riiAi  Ai{K  i!\i)  i(»i{  iiii:  \^\\^\ 

'I'lii-  lilli-  liiiiiu  i)\('r  llic  cntrnncc  <it'  llic  t'oycr.  Tlic  lover  \\;i>  M'paratcil  rrcnn 
tlio  main  cxliiliitioii  liall  hy  the  corridors  siirroimdiiiii  liic  stairway.  For  this 
reason  it  was  sele(t<'(l  as  the  place  in  wliicli  to  show  the  thinus  liial  are  hail  for  the 
liaKy,  so  that  there  could  l)e  no  jiossihle  conl'n-ion  in  the  minds  of  miillier-  as  to 
what  was  uood  and  what  was  had. 

'I'lie  Icillduini;  lliiniis  were  shown  here; 

IJad   l.iviNc  .\Ni)  Si.i;i;i'i\(;  Rooms 
H one.     Sif^n:  "    Tni^   |{<mi\i   is   Iniit  to  I,i\  k  In.     Wiiv'"" 

The  windows  in  this  room  were  tightly  ilosed.  'I'he  lloor  was  co\  ered  with  a 
dirty,  frayed  eari)et.  'I'he  room  eonlained  some  rickety,  nnpainled,  mutilated 
chairs,  a  lalile  on  which  were  placed  a  piece  of  l>read.  a  can  of  tomatoes,  a  can  of 
])eas,  an  open,  ])arliall.\  emptiec!  milk-hottle.  and  an  oil-lamp.  Over  the  various 
articles  and  the  tahle  were  scattered  many  artificial  flies.  .\  manikin  doll,  repre- 
sentinu'  .-i  child,  seated  at  the  lahle,  was  pn'snm.ahlx-  eni;at;cd  in  ealinu'  tomatoes, 
which  were  --nK'ared  over  his  cheeks.  .M)o\c  the  child  wa^  [)la<-ed  a  siun  readinj;': 
"Keep  ( 'hildreu  Clean." 

Another  manikin,  representing;  a  liah.v,  was  pl.iced  in  a  jjo-cart.  The  hahy 
held  a  dirty,  ordinary  hottle  containinuciirdled  milk.  .\  si^n  allached  lo  the  jfo- 
cart  read;    ""'Ihis  Mahy  is  Too  ^  ount;  For  a  (io-('art.' 

There  was  a  chair  upotl  which  was  place<l  a  supposedly  sick  cat,  and  the  cat 
was  heini;  stroked  l>v  another  small  child  i  r<'present<'il  1)>-  a  manikin  doll',  'i'his 
chair  eonlained  I  he  sii;n, ""  I'ets  Carry  Disea.se." 

(lose  liy  I  he  lalile  was  placed  a  !iarl>at;e  can  lilleil  with  izarliauc  I  pon  this 
was  |ilaced  a  sii^n.  ■'keep  the  Slop  (an  ('oxercil. 

Close  l)y  were  two  si^iis  readiiii^;  "  Keeji  llic  l-'lic-  Out"  and  ""Keep  the 
\Viiid()Ws  Open  hut   Closely  Screened." 

In  a  corner  of  the  room  was  |)lacc(i  a  cookiiii;  raniie,  and  upon  it  were  some  old 
l)ots  and  jians. 

In  another  corner  of  the  room  were  se\cral  soiled  diajn-rs,  and  oil  a  clothesline 
stretched  across  the  room  were  huiii;-  two  diapers.  On  this  line  was  linn<;  also  a 
legend  reading:  ■"When  the  Bahy's  Diaper  is  Soiled,  Change  and  Wash  it  at  Once." 

There  were  three  other  signs  in  the  hooth,  which  read:  (\)  "I'ut  Hahies  to 
Sleej)  hy  Seven  O'Clock.  They  Do  Not  (Jet  Enough  Sleep  If  Kept  I'p  Late."  ('•2) 
"The  Bahy  Should  Sleep  in  a  Crih  and  Without  a  Pillow."  (S)  "A  Bahy  Needs 
From  l(i  to  20  Hours  of  Sleep  in  Each  24,  In  a  (jiiiet  Room,  In  Ilis  Own  Crih,  With 
Plenty  of  Fresh  .Vir  and  No  Flies,  and  Placed  I'lion  a  Soft  Feather  Mattress." 

Room  two.     Sign:  "This  Room  is  Unfit  to  Sleep  In."     Why? 

The  floor  of  this  room  was  also  covered  with  a  dirty  carpet:  the  windows  were 
tightly  shut,  and  a  hreak  in  the  window  was  filled  with  rags.  A  sign  placed  on  the 
window  read;    "Sleep  With  The  Windows  ()])en." 

The  room  contained  a  wooden  Ix-d,  and  in  it  were  manikins  representing  a 
mother  and  a  sleejiing  hahy.     The  hed  was  covered  with  a  dirty  comfort.     Signs 


146 


niRFJTdHV  AM)  (  ATMJX.ri:  OF  F.MIIIU'IS  U? 

oil   tlii--   lied   rr:i(l:     "'llii'    I?ai),\'  Shdiild   Slfc|>   in   ;i   (rili."  and   "Tlic    l?c(|   (  liillics 
Should   !)(•  ^^'a^ll;^l)l(■  a?id  \\aslicd." 

A  chair  |)hicc<l  near  tiic  hcd  liad  a  dirty  apron  thrown  oxer  tlic  hack  of  il.  and 
ii|)<)ii  it  was  jihiced  a  hinip.  There  were  two  sij;tis  on  (his  chair,  otic  readinii  "Do 
Not  Allow  das  to  ]{nrn  in  Hal).\"s  Sleepiiia-  Room";  and  the  other,  "'Inrii  out  all 
Light  in  tiie   i{al)y's  l?ed  Hooiii." 

On  a  table  in  the  room  was  |)laced  a  hottle  of  milk  lor  use  in  the  nit;ht.  .ind 
n|Mpn  this  was  a  sifin  readiiia:   "This  Will  I'rohahiy  Soni- " 

I'liere  was  a  bureau  in  (he  room  on  wliicii  were  scattereil  a  nnml)er  of  articles  of 
elotllinji.  It  was  pointec!  out  that  a  bureau  siiould  l)e  moxabie  or  clexated  above 
the  floor  to  make  it  possible  to  clean  beneath  it . 

Another  chair  containe(l  lh<'  garments  of  the  mollicr  and  child  loosely  piled 
upon  it,  and  over  this  was  a  siiiii  reading;:   "Clothes  Should  be  ( 'arefull>    lluni;  I  p." 

'I'here  was  a  cuspidor  on  the  floor,  and  oxer  it  a  sii;n  readiiiii,  "This  Should  be 
Made  of  Metal  a.s  it  is  Easier  to  Keep  (lean.      Il  Should  l?e  Ke|)l  Coxcreil." 

There  was  also  .a  comnioile  in  the  room,  and  oN'er  it  a  sign  which  read.  "II  I  sed 
at  all.  il  Shonlcl  be  Kept  <  dx  crcd  and  Fre(|Uenl  l>-  and  Thoroughly  ( 'Icansccl." 

The  reni.aindcr  of  llic  foxcr  was  dixided  into  four  booths,  as  follows: 


Patent  Medicines  and  Soothin,sx  S//rups 

|S-o  I'hitt-  XI.IX.] 

li.K.th    1. 

In  the  central  portion  of  this  booth  was  a  draxving  of  a  hand  of  a  skeleton  hold- 
ing in  its  clasp  eight  bottles  of  the  anodynes  in  common  use.  On  either  side  of  it 
were  enlarged  photograi)hi<-  reproductions  of  the  labels  of:  Fitler's  Soothing  Car- 
minative, Hooper's  Anodyne.  Dr.  I'"aliev"s  Pepsin  .\nodyne,  and  Mrs.  Win>low"s 
Soothing  Syru]). 

.\t  one  end  oi  the  iiootli  xvas  a  photograph  of  tixe  bottles  containing  laudanum, 
with  labels  recommending  them  a,s  valuable  in  (piieting  babies,  and  on  the  ojjposite 
end  was  a  photograph  of  seven  bottles  of  alleged  di()htheria  cures  and  preventives. 
On  two  shelves  in  the  central  portion  of  the  booth  there  were  ^2!)  bottles  containing 
different  anodynes  and  soothing  syrups,  and  above  them  was  written  the  legend: 
"These  all  contain  opium.     They  may  make  yiiur  liaby  sick." 

Heneath  the  shelves  there  were  three  ])hotograi)hic  illustrations  of  bottles  con- 
taining soothing  syrui)s,  representing  a  total  of  4iS. 


11 


14S 


DIRECTOR)    AM)  <  AT. {/.()(. IF.  OF  FMIIHITS  149 

Patent  Foods 

Booth  i 

Tliis  lidolli  ((iiitainccl  a  iniinlicr  iil'  [atcnt   f U.      It  \va^  pdiiitnl  (Hit   lliat  tlic 

majority  of  micIi  fooil>  contain  an  <'x<c>si\<'  anionnl  of  >tan-li  and  snt;ar.  and  tliat, 
in  order  to  hrini;  the  anionnts  of  these  inL:re(lients  down  to  tlie  normal,  it  \\a> 
necessary  to  reduce  the  protein  and  fat  content  to  siicli  a  low  |-oint  as  to  render  them 
of  little  value  as  foods.     There  was  shown  a  chart  em|ihasi/,ini:  th<-  relative  vahie 

of  ])alent   f Is,  mother's  milk,  and  cow's    milk.      There   were   -.oiue   pliotoirraphs 

of  rachitic  ami  iiiMrasmic  infants  who  hail  heen  fed  on  >ome  of  the  patent  foods. 
Uiiderneat  h  one  of  I  he  photojiraijlis  re|)resentinf;  a  child  u  il  h  rickets  was  the  legend  ; 
"A  child  fed  on  food  other  than  hreast  milk  often  {i'cts  ricket-." 

Tlii-oimhollt  this  hootll  esjx'cial  emphasis  was  laid  on  the  importance  ot  a 
.snfficient  amount  of  fat  and  protein  in  all  foods,  and  the  danger  of  e\cessi\e  starch 
and  snt;ar,  and  the  fact  that  most  i)ateiil  f Is  are  delicient  in  the  former  ingre- 
dients and  contain  an  excess  of  the  latter. 

I'ertaining  to  the  general  |)rol>lem  of  feeding  there  was  a  sign  which  read: 

'■'I'wo  tlics  in  May. 
.V  million  in  .Inly. 
.V  sick  l)al>.\'  in  .Inly. 
Kill  e\er>'  fl.\'.'" 

Heneath  this  was  hung  a  home-made  tly-killcr,  .iiid  .-it  t,-ichc<l  to  il  was  the 
ad\  ice: 

"M.'dse  one  of  thc^e  for  every  room  in  the  house'" 

Booth  3.     (See  Plate  L.) 

This  booth  eontaineil  on  the  right  screen  a  sign  reading: 
"Tins  IS  Wh.vt  II.vppens  When  the  Baby  Uses  a  Comfokteh" 

Immediat<'ly  heneath  was  an  illustration  of  .-i  Petri  plate  showing  the  ciiltnres 
made  from  a  hahy  comforter,  and  helow  a  white  craiie.  sncli  as  is  |)laced  on  doors 
of  houses  to  indicate  an  infant's  death. 

Next  was  a  sign,  "See  What  Happens  to  the  IJahy."  and  liencath  it,  two  i>lioto- 
grai)hs  of  hahies  heing  given  milk  from  a  hottle  through  tnlies,  and  lielow  was  a 
jihotograph  of  two  crihs  in  a  hos|)ital  containing  hahies. 

Beneath  wa,s  a  sign  reading  "  Keej)  the  Nipples  Clean.  Dirty  Nipjilcs  Make 
Pure  Food  I'ntit  to  Use." 

Below  was  placed  a  nijiple  with  a  tuhe  and  the  legend:  "Do  Not  I  se  This 
Kind,"  and  heside  it  an  ordinary  cone-shaped  ni|)ple,  with  the  legend:  "T'se  Thi.s 
Kind." 

Beside  this  was  a  hottle  with  a  tuhe  nipple  attached,  and  imdi'rneath  it  was 
written,  "This  Kind  of  Nipple  Shoidd  Not  Be  Used.     See  What  IIa|)|ieiis." 

Below  was  a  photogra])h  of  a  Petri  plate  containing  colonies  of  haiteria,  and 
below  this  a  i)hotograi)h  showing  the  mother  grieving  over  a  sick  child. 

Next  was  a  |)icture  of  a  baby  in  bed;  a  hot-water  bottle  had  bei'ii  ])laced  in  lied 
beside  the  baby,  and  being  too  hot,  had  caused  a  burn.  Beneath  was  the  legend: 
"See  How  it  Burned  the  Baby." 

In  the  center  <if  this  .screen  was  a  sign  reading  "This  May  Injure  the  Baby," 
and  beneath  it  four  jjhotographs:  (DA  baby  sucking  its  thimib;  (i)  a  mother 
jogging  the  baby  on  her  knee;  i.S)  a  mother  holding  a  baby  at  arm's  length  al)ove 
her  head;   and  (4)  a  baby  with  bright  smdight  shining  in  its  e.ves. 


Plate  LI 
FOYER— MECHANICAL  DEVICE  INDICATING  FREQUENCY  OF    DEATHS  OF  INFANTS 


150 


DIRECTORY  AM)  CATMAUHE  OF  EXIIIIilTS  151 

On  n  shelf  ajj;aiii.st  this  center  screen  were  placed  lliree  diiMy  toys,  a  (|iiarl  of 
milk,  a  (piart  of  li(|niil  lieef  preparation,  a  (|Uart  jar  half  fnll  of  whisky.  aTi<l  a  (piart 
hot  tie  containini;  inijjnri'  alcohol:  sonic  improper  rectal  syringes  and  a  doll  illustrat- 
ing shoes  which  were  laced  too  tiuht.      Ahoxc  these  were  I  he  following  si^ns: 

(1)   "Dirty  riaythiniis  Carry  Disease." 

(i)  "'I'his  (^uart  of  Milk  Costs  Kiulit  Cenls,  Docs  Not  Contain  Alcohol.  Will 
Nourish  The  Mahy  ','4  Hours";  "ThisC^uart  of  l,i(piid  Meef  I'reiiaration  Costs  $1.70, 
Does  Not  Contain  As  Much  Xourishment  As  This  .Milk,  and  (dniains  Kiiough 
Alcohol  to  Make  I  he  Hahy  Drunk." 

(■'5)  "This  Whisky  Contains  the  Same  .\moiuil  of  .Mcohol  as  Ihc  l,i(|uid  Hecf 
I'rei)aration." 

(4)  "This  is  the  lTiii)urc  .Mcohol  Cotitained  in  the  Hecf  I'reparalion." 

(5)  "This  Syriufic  Will  Hurt  the  IJahy;    Nozzle  'I'oo  Hard  an<l  'I'oo  l.oiij,'. 
((!)  "This  Lacing  is  Too  Tight.  If  Will  Hurl  the  Hal.y's  Fool." 

On  the  left  screen  were  the  followinj;:  A  photoitraph  of  a  molher  walkini;  in 
tiie  .street,  liftinji;  the  l)al)y  from  the  street  to  the  sidewalk  hy  one  arm.  The  lefjcnd 
beneath  read:   "If  ^'ou  Lift  a  Hahy  in  This  Way.  \\n\  May  Hurt  its  .\rm."' 

A  i)hot()graph  of  a  molher  roekinu  a  l)ali>.  The  Icfjcnd  henealh  read:  "Do 
Not  Kock  the  Hahy  After  Feeding:   it  Makes  it'\omil." 

A  i>hologra|)li  of  a  hahy  eating  a  hanana.  The  legeml  lienealh  read:  "The 
Doctor  Will  he  Called  Tonight." 

.\  photograph  of  a  mot  her  kissing  a  lial)>'.  The  Icgc'ud  lienealh  read:  "Do 
Not.  Kiss  Ihc  Uahy;    il  Spreads  Di.sea.sc." 

Photographs  of  two  hahies  wrapped  in  sw  addling  clol  lies.  The  legend  hencath 
read:    "IJahies  Dressed  in  This  Way  Caniiol   Kxercise." 

One  large  sign  in  the  booth  read,  "Do  Not  .Mlow  Babies  lo  Walk  Too  Ivirly; 
it  Tends  to  Make  Them  Bow-I>cgged." 

Bootli  i.      (S.-(-  I'lato  1,1.) 

Tllis  booth  contained  a  device  which  graphically  indicali'd  llic  frccjucney  of 
infants'  deaths. 

It  was  in  the  form  of  a  railroad  <ros>ing  guarded  by  a  drop  gate.  A  train  wa.s 
pa.ssing,  and  children.  re])resented  by  niinule  dolls,  were  ])layiiig  about  the  tracks. 

The  train  consisted  of  three  cars:  the  first  was  painted  red,  and  contained  the 
legend:  "Diarrheal  Diseases":  the  second,  blue,  and  contained  the  legend,  "The 
Diseases  of  Farly  Infancy  ";  and  the  third,  yellow,  and  contained  the  legend, 
"Lung  Di.seases." 

The  drop  gate,  which  was  operated  mechanically,  fell  and  rose  every  ten  .second.s. 
Al)o\e  this  device  was  placed  the  following  sign: 

"  .'?.'24.'!.0.)S  Habies  in  the  Civilized  World  Die  During  Their  First  ^'ear 
of  Life.  One-(|uarter  of  all  the  dead  who  die  in  the  registration  area  are 
dead  before  they  reach  their  second  year.  Of  Every  Five  Babies  Horn, 
One  Dies  During  The  First  Year.  About  one-half  of  this  loss  is  })re- 
ventable.  What  will  you  do  about  it?  Out  of  100  Bottle-fed  Babies, 
50  Die;    Out  of  100  Breast-fed  Babies,  7  Die." 

To  its  left  was  the  following  sign: 

"What  Can  You  Do  About  It?  Nurse  your  baby.  Don't  feed  baliy 
just  because  it  cries;  feed  baby  at  regular  hours.  Keep  the  baby  clean  and 
dry.  (live  the  baby  plenty  of  water.  Demand  pure  food  for  your.self  as 
well  as  for  the  babv.     Trv  the  fresh  air  cure." 


152        REPORT  OF  THE  PHILADELPHIA  RARY  SAVING  SHOW 

To  its  riglit  was  the  following  sign: 

"What  Can  You  Do  About  It?  Screen  the  windows  and  doors  and 
baby's  crib.  Remove  the  filth.  Clean  uj)  your  back  yard.  Keep  baby 
awav  from  sick  children.  Read  the  liaby  Saving  Pamphlet  on  the  "Care 
of  The  Baby.'     Obey  Health  Law." 

ACROSTICS 


Measles. 

Easiest  disease  to  catch. 

Alarming  in  infants. 

Scores  too  many  deaths. 

Loose  cjuarantine  s])reads  it. 

Expose  no  child  to  it. 

Sane  mothers  ])rotect  their  children. 


Scarlet  Fever. 

Contagious  and  costly. 

Avoidable,  unnecessary. 

Ravages  child  life. 

Leaves  many  cri|)i)lc(l. 

Ends  often  fatally. 

Thoughtfulness  and  Watihfulness  may  jjrevent  it. 

Flourishes  in  Winter. 

Exiles  the  afflicted. 

^'an(|uislles  hai)piness. 

Entraps  the  careless. 

Requires  strict  quarantine. 


Diphtheria. 

Lidifference 

to  it  is  fatal. 

Prom])t  trea 

tment  is  necessary. 

Hospitalizai 

ion  gives  control. 

Terminates 

too  many  lives. 

Hostile  to  c 

lild  life  es|)ecially. 

Entraps  the 

careless. 

Re(|uires  strict  quarantine. 

Is  curable. 

Antitoxin  cures  it. 

(The  first  letter  of  eacti  line  was  printcil  in  brilliant  Red  color.) 


niRFJToRY  AX/)  c.iTAf.oari:  or  kxiiiiuts 


(.(KID  IIKAI.III  AI.IMIMiF.I' 

A  is  for  Air.  wliidi  ;ill  of  us  nccij. 

1$  is  for  Hrcatiiiiii;  (iccp;    kiii(if\'  (mInc  iici-d. 

C  is  for  Consiiniption,  thai  kilN  yoiiiit;  and 

old 

D  is  for  Dirt,  with  its  danucrs  uiilold. 

E  is  for  Katiiis;  food  yood  and  pure. 

F  is  for  Fhes  wi-  slionld  not  cnihirc. 

(i  is  for  (iiviiiff  hcaltli  kno\vlcdi;c  lo  all. 

II  is  for  Health  for  llic  j;rcat  and  th<-  small 

I  is  for  Illness,  for  wliicli  we  are  to  hlanx-. 

J  is  for  Jenner.  the  niaii  of  ^reat  fame. 

K  is  for  Kiiowledn'e,  to  make  lis  <;row  stron 

4er 

L  is  for  Learning;,  that  we  may  live  loii<.'er. 

M  is  for  Mouth,  for  reeeixiny  our  food. 

\  is  for  Xotini;  the  thiniis  that  are  uood. 

()  is  for  Order  in  all  that  we  do. 

I'  is  for  Pasteur,  a  scientist  tru<'. 

Q  is  for  (Questions  of  health  wf  always  ^lnii 

Id  ■• 

isk. 

K  is  for  l{ii;ht   Reading,  a  |>rolital)l<'  task. 

S  is  for  Sunshine.  th<'  foe  of  disease. 

T  is  for  'rem|)tatiou,  to  loll  at  our  ease. 

V  is  for  I'nkiiiduess,  itself  a  grax-e  sin. 

\'  is  for  Wssels  for  drinkiiii;.  clean  as  a  pin 

W  is  for  Washing;-,  to  l>e  health\   ,ind  clean. 

X  is  for  X-ray,  to  find  the  unseen. 

^"  is  for  ^'outh.  the  lusty  and  slrons,'. 

/  is  for  Zeal  to  live  wisely  and  lon^. 

154       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Hospitals  and  Institutions 

Photographs,  Cliarts,  Models,  and  Descriptive  Signs  were  Exhibited  l)j' 
the  following  Hospitals  and  Institutions: 

Children's  Hospital  of  Philadelphia. 

St.  Margaret's  House  and  Hospital,  Albany.  New  York. 

f^hildren's  Homeopathic  Hospital,  Philadelphia. 

("hildrcn's  Seashore  House,  Atlantic  City. 

Tiic  Philadelphia  Hnnie  for  Infants. 

Penn.sylvania  State  Congress  for  Mothers. 

Children's  Aid  Society,  Philadelphia. 

The  Philadelphia  A.ssociation  of  Day  Nurseries. 

Babies'  Hospital  of  Philadelphia. 

The  Russell  Sage  Foundation. 

The  Speedwell  Society. 

St.  ^'incent's  Home. 

Philadelphia  ModiKed  Milk  Society. 

Jefferson  Maternity  Hospital. 

St.  Christopher's  Hos])ital. 


Lectures  and  Speakers 


12 


LECTURES  AND  SPEAKERS  AT  THE  BABY  SAVING  SHOW 

Moving  Picture  Demonstration  at  12.50  p.  m.  Each  Day 

Moving  Picture  Demonstration  Immediately  Preceding  and  Following  Each  Lecture 

Saturday,  Maij  18th,  3  P.  M. 
Presiding  Officer: 

Dr.  S.  McC.  Hamill,  Professor  of  Diseases  of  Children,  Philadelphia  Poly- 
clinic. 

Address  of  Welcome: 

Mr.  George  D.  Porter,  Director  of  the  Department  of  Public  Safety  of 
Philadelphia. 

1.  The  Infant  Death  R.vte  in  Philadelphia  and  What  the  Department  of 

Public  Health  and  Charities  is  Doing  for  its  Reduction: 

Dr.  Joseph  S.   Neff,   Director  of  the  Department  of  Public  Health   and 

Charities  of  Philadelphia. 

2.  What  is  Being  Done  by  the  Phil.\nthropic  Organizations  of  Phila- 

delphia for  the  Protection  of  the  Life  and  Health  of  Infants: 
Mr.  Edwin  D.  Solenberger,  General  Secretary  of  the  Children's  .\id  Society 
of  Pennsylvania. 

8  P.  M. 

Presiding  Officer: 

Dr.  Joseph  S.  Neff,  Director  of  the  Department  of  Public  Health  and 
Charities  of  Philadelphia. 

1.  The  Importance  of  Breast-Feeding: 

Dr.  L.  T.  Royster,  of  Norfolk,  Va.,  ^'ice-chairman  of  the  Section  on  Diseases 
of  Children  of  the  American  Medical  Association. 

2.  How  to  Continue  Breast-Feeding  Under  Difficulties: 

Dr.  M.  Howard  Fussell,  Professor  of  Apphed  Therapeutics  in  the  Medical 
Department  of  the  University  of  Pennsylvania. 

Sunday,  May  19th,  3  P.  M. 

Lectures  in  Italian 
Presiding  Officer: 

Chevalier  C.  C.  A.  Baldi. 

1.  The  Importance  of  Breast-Feeding    and    the  Dangers  of  Artificial 

Feeding: 

Dr.  Henry  M.  Fisher,  of  Philadelphia. 

2.  How  to  Care  for  the  Infant  During  the  Summer  Months: 

Dr.  Ignazio  Cortese,  of  Philadelphia. 

157 


158       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Domenica  19  Maggio,  alle  3  P.  M. 

SoTTO  LA  Presidenza: 

del  Sig.  Cav.  C.  C.  A.  Baldi, 

Dr.  H.  M.  Fisher,  dara  un  discorso  sopra  L'  Importanza  di  Nutrire  il 
Bambino  d'al  seno  ed  anche  sopra  Pericoli  del  Nutrimento  Artificiale 
del  Bambino. 

II  Dottore  Ignazio  Cortese  di  Philadelphia  parlera  della  Cara  del 
Bambino  durante  la  Stagione  Calda. 

8  P.  M. 

Lectures  in  Yiddish 
Presiding  Officer: 

Mr.  Joseph  Gross,  of  Philadelphia. 

Introductory  Remarks: 

Rabbi  B.  L.  Levinthal,  of  Philadelphia. 

1.  The  Importance  of  Breast-Feeding    and  the  Dangers  of  Artificial 

Feeding: 

Dr.  Bernard  L.  Kahn,  Member  of  the  Philadelphia  Pediatric  Society. 

2.  How  TO  Care  for  the  Infant  During  the  Summer  Months: 

Dr.  Solomon  Seilikovitch,  Member  of  the  Philadelphia  Pediatric  Society. 

Monday,  May  20th,  3  P.  M. 

Presiding  Officer: 

Dr.  William  M.  AVelch,  Chief  Diagnostician  to  the  Bureau  of  Health  of 
Philadelphia. 

1.  Vaccination  and  Its  Influence  Upon  the  Infant  Death  Rate: 

Dr.  Jay  F.  Schamberg,   Professor  of  Diseases  of  the  Skin,   Philadelphia 
Polyclinic. 

2.  Diphtheria — Its  Cure  and  Prevention: 

Dr.  John  A.  Kolmer,  Professor  of  Pathology,  Philadelphia  Polyclinic. 

8  P.M. 

Presiding  Officer: 

Mr.  J.  A.  Vogelson,  Chief  of  the  Bureau  of  Health  of  Philadelphia. 

1.  The  Advantages  of  Milk  Over  the  Advertised  Substitute  Foods  fob 

Babies: 

Dr.  J.  Claxton  Gittings,  Instructor  in  Children's  Diseases,  Medical  Depart- 
ment of  the  University  of  Pennsylvania. 

2.  Infant  Mortality  and  the  Milk  Question: 

Dr.  D.  J.  Milton  Miller,  of  Atlantic  City,  Member  of  the  American  Pedi- 
atric Society. 


LECTURES  AND  SPEAKERS  159 

Tuesday,  May  21st,  3  P.  M. 
Presiding  Officer: 

Dr.  Charles  A.  Fife,  Instructor  in  Children's  Diseases  in  the  University 
of  Pennsylvania. 

1.  The  Care  of  the  Newborn  Infant: 

Dr.  E.  P.  Davis,  Professor  of  Obstetrics,  Jefferson  Medical  College,  Phila- 
delphia. 

2.  What  Should  be  Demanded  of  the  Midwife: 

Dr.  George  A.  Ulrich,  Assistant  Professor  of  Obstetrics,  Jefferson  Medical 
College,  Philadelphia. 

8  P.  M. 

Presiding  Officer: 

Mrs.  R.  Tait  McKenzie,  Chairman  of  the  Public  Health  Committee  of  the 
Civic  Club  of  Philadeljjhia. 

1.  The  Extermination  of  the  Typhoid  Fly  fro.m  a  City  (Lantern  Slide 

Demonstration)  : 
Dr.  C.  F.  Hodge,  Professor  of  Biology,  Clark  University,  Worcester,  Ma.ss. 

2.  The  Importance  of  Fresh  Air,  Light  and  Cleanliness  in  the  Home: 

Dr.  Henry  I.  Bowditch,  of  the  Department  of  Diseases  of  Children,  Har- 
vard Medical  School,  Boston,  Mass. 

Wednesday,  May  22d,  3  P.  M. 

Presiding  Officer: 

Dr.  L.  J.  Hammond,  President  of  the  Philadelphia  County  Medical  Society. 

1.  SuM>iER  Diarrheas — Their  Causes  and  Prevention: 

Dr.  J.  W.  Schereschewsky,  of  the  U.  S.  Department  of  Public  Health  and 
INIarine  Hosj)ital  Service,  Washington,  D.  C. 

2.  The  Influence  of  Measles  and  Whooping  Cough  Upon  Infant  Mor- 

tality : 

Dr.  Royal  S.  Haynes,  Instructor  in  Diseases  of  Children,  Columbia  Uni- 
versity, New  York. 

8  P.  M. 

Presiding  Officer: 

Dr.   C.  J.   Hatfield,   Vice-chairman  of    the    Executive  Committee  of  the 
Baby  Saving  Show. 

1.  What  the  Consumer  Should  Demand  of  the  Milkman: 

Dr.  Henry  L.  Coit,  Ex-President  of  the  American  Association  of  Medical 
Milk  Commissions,  Newark,  N.  J. 

2.  The  Care  of  Milk  in  The  Home: 

Dr.  Howard  Childs  Carpenter,  Instructor  in  Diseases  of  Children,  Univer- 
sity of  Pennsylvania. 


160       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Thursday,  May  23d,  3  P.  M. 
Presiding  Officer: 

Dr.  J.  Torrance   Rugh,  Orthopedic   Surgeon   to  the  Methodist  Episcopal 
Hospital  of  Philadelphia. 

1.  Recreation  Piers  and  City  Parks  in  Relation  to   Infant   Mortality 

(Lantern  Slide  Demonstration)  : 

Miss  Ellen  C.  Babbitt.  Special  Agent  of  the  Department  of  Child  Helping 
of  the  Russell  Sage  Foundation,  New  York. 

2.  Day  Nurseries — Their  Value  and  Limitations: 

Miss  Alice  Biddle,  of  Philadelphia. 

8  P.  M. 
Presiding  Officer: 

Dr.  Henry  D.  Jump,  Chairman  of  the  Committee  on  Infant  Mortality  of 
the  Philadelphia  County  Medical  Society. 

1.  Influence  of  III  Health  in  Infancy  Upon  the  Future  Development 

of  the  Child: 

Dr.  Henry  D.  Chapin,  Professor  of  Diseases  of  Children  in  the  New  York 

Post-Graduate  Medical  School. 

2.  Cause  and  Serious  Results  of  Sore  Eyes  in  the  Newborn  (Lantern 

Slide  Demonstration): 

Dr.  Thomas  B.  Holloway,  Instructor  in  Diseases  of  the  Eye,  Medical  De- 
partment of  the  University  of  Pennsylvania. 

Friday,  May  S^th,  3  P.  M. 
Presiding  Officer: 

Dr.  Theodore   LeBoutiUier,  Professor   of  Diseases  of  Children,  Women's 
Medical  College  of  Philadelphia. 

1.  How  to  Clothe  the  Baby: 

Dr.  John  F.  Sinclair,  Visiting  Physician  to  the  Babies  Hospital  of  Phila- 
delphia. 

2.  General  Care  of  the  Baby: 

Dr.   Alfred  Hand,   Jr.,   Visiting  Physician  to  the  Children's  Hospital  of 
Philadelphia. 

8  P.M. 

Presiding  Officer: 

Dr.  Ward  Brinton,  Director  of  the  Babies  Hospital  of  Philadelphia. 

1.  What  Life  in  the  Home  Should  Be: 

The  Right  Reverend  Philip  M.  Rhinelander,  Bishop  of  Pennsylvania. 

2.  Tuberculosis  in  Relation  to  Infant  Life: 

Dr.  H.  R.  M.  Landis,  Clinical  and  Sociological  Director  of  the  Henry 
Phipps  Institute. 


LECTURES  AXD  SPEAKERS  161 

Saturday,  May  2oth,  3  P.  M. 
Presiding  Officer: 

Dr.  William  Duffield  Robinson,  of  Philadelphia. 

1.  The  Care  of  the  Mother  During  Pregnancy  and  the  Preparation  for 

Confinement  : 

Dr.  William  R.  Nicholson,  Professor  of  Diseases  of  Women,  Philadelphia 

Polyclinic. 

2.  The  Care  of  the  Mother  During  Her  Lying  In: 

Dr.  Richard  C.  Norris,  Physician  in  charge  of  Preston  Retreat. 

8  P.  M. 

Presiding  Officer; 

Mr.  Alexander  M.  Wilson,  Assistant  Director  of  the  Department  of  Public 
Health  and  Charities  of  Philadelphia. 

1.  The  Value  of  a  Baby's  Life: 

Dr.  Edward  J.  Cattell,  Chief  of  tiic  Bureau  of  Contracts  and  Statistics 
of  the  Office  of  The  Mayor,  Philadelphia. 

2.  Philadelphia's  Need  of  \  Municipal  Child  Bureau: 

Dr.  Jesse  D.  Burks,  Director  of  the  Bureau  of  Munici[)al  Research  of  Phila- 
delphia. 

Sunday,  May  26th,  3  P.  M. 
Presiding  Officer: 

Dr.  Elizabeth  L.  Peck. 

1.  What  Women  Can  Do  to  .\id  in  the  Reduction  of  Infant  Mortality: 

Dr.  Eleanor  C.  Jones,  Visiting  Physician  to  the  Children's  Wards  of  the 
Women's  Hospital. 

2.  What  Children  Can  Do  to  Aid  in  the  Reduction  of  Infant  Mortality: 

Mrs.  J.  Scott  Anderson,  of  the  Home  and  School  League  of  Philadelphia. 


LECTURES  AXD  SPEAKERS  AT  THE  SUBSIDIARY 

SHOWS 

DOWN-TOWN  SUBSIDIARY  SHOW 

310  Catharine  Street 
Wednesday,  May  29th: 

Dr.  Theodore  Le  Boutillier — The  Clothing  of  the  Baby  and  the  Care  of  the 

Baby. 

Dr.  Bernard  T.  Kahn — Care  of  the  Milk  and  Breast-Feeding. 

Thursday,  May  30th,  8  p.  m.  : 

Dr.  Maxwell  Herman — Care  of  the  Infant  During  the  Summer  Months. 
Dr.  John  Penza — Care  of  the  Milk  in  the  Home. 


162       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Friday,  May  31st,  8  p.m.: 

Dr.  Ignazio  Cortese — Care  of  the  Infant  During  the  Summer  Months. 
Saturday,  June  1st,  8  p.m.: 

Dr.  Maurice  Goldberg — Care  and  Modification  of  Milk. 

THE  KENSINGTON  SUBSIDIARY  SHOW 

Howard  and  Cambria  Streets 

Thursday,  June  6th,  8  p.  m.  : 

Dr.  Howard  Childs  Carpenter — The  Selection  and  Care  of  Milk  in  the  Home. 
Dr.  J.  Clinton  Foltz— FUes. 

Friday,  June  7th,  8  p.  m.  : 

Dr.   Charles  A.   Fife — How  to  Care  for  the  Infant  during  the  Summer 

Months. 

Dr.  John  F.  Sinclair — How  to  Bathe  and  Clothe  the  Baby. 

Saturday,  June  8th,  3  p.m.: 

Mr.  Edwin  D.  Solenberger — Wet  Nursing. 

Saturday,  June  8th,  8  p.  m.  : 

Dr.  Alfred  Hand,  Jr. — The  General  Care  of  the  Baby. 
Dr.  Theodore  Le  Boutillier — The  Advantage  of  Breast-Feeding  over  Arti- 
ficial Feeding. 

Sunday,  June  9th,  3  p.  m.  : 

Dr.  D.  M.  Hoyt — The  Prevention  of  Tuberculosis  in  Infancy. 

Dr.  Hanna  Kindbom — What  Women  can  do  in  the  Reduction  of  Infant 

Mortality. 

Sunday,  June  9th,  8  p.m.: 

Dr.  Charles  H.  Weber — How  to  Continue  Breast-Feeding  under  Difficulties. 
Dr.  Charles  N.  Sturtevant — ^Advantages  of  Milk  Over  the  Advertised 
Proprietarj'  Foods. 

GERMANTO^^  SUBSIDIARY  SHOW 

5849  Germantown  Avenue 
Thursday,  June  13th: 

Dr.  J.  CHnton  Foltz — Instruction  and  Demonstration  to  the  Demonstrators. 
Dr.  Wm.  R.  Nicholson — Care  of  the  Mother. 

Friday,  June  14th: 

Dr.  H.  B.  Wilmer — Eugenics  and  Heredity. 

Dr.  John  J.  Mullowney — Social  Diseases. 

Dr.  W.  B.  Fetterman — Care  of  the  Child  and  General  Hygiene. 

Saturday,  June  15th: 

Dr.  Robert  L.  Pitfield— Modification  of  Milk. 
Sunday,  June  16th: 

Dr.  Robert  Downs— The  Care  of  Milk. 

Dr.  Josephus  UUom — The  Care  of  the  Baby. 

Theodore  Le  Boutillier — The  Clothing  and  Care  of  the  Baby. 


LECTURES  AND  SPEAKERS  163 

MANAYLNK  SUBSIDIARY  SHOW 

Main  and  Rector  Streets 

Thubsday,  June  20th,  8  p.  m.  : 
Subject — Breast- Feeding. 
Speaker — Dr.  M.  Howard  Fussell. 

Friday,  June  21st,  8  p.m.: 

Subject — Care  of  the  Baby. 

Speaker — Dr.  Theodore  Le  Boutillier. 

Saturday,  June  22d,  8  p.  m.  : 

Subject — Milk  Feeding.     Subject — Diseases  of  the  Eye. 
Speaker— Dr.  O.  H.  Petty.     Speaker— Dr.  T.  B.  HoUoway. 

Sunday,  June  23d,  3  p.  m.  : 

Subject — Contagious  Diseases. 
Speaker — Dr.  J.  D.  Lehman. 

Sunday,  June  2d,  8  p.  m.  : 

Subject — Artificial  Feeding. 
Speaker — Dr.  H.  C.  Carpenter. 

DAILY  ATTENDANCE  AT   THE   MAIN  EXHIBIT,  HORTICULTUR.\L 

HALL 

The  Hall  was  open  from  10  a.  m.  to  10  p.m.,  except  on  Sundays,  when  it  was  open  from 

1  P.M.  to  10  P.M. 

Saturday,  May  18,  li)l'2 3,iia 

Sunday,  May  19th 1,!»08 

Monday,  May  iOlh      3,965 

Tuesday.  May  ilst     +.344 

Wednesday.  May  2^(1 9.413 

Thursday." May  «3d U.iOi 

Friday,  Mav:e4th 11,175 

Saturday.  May  25tli 13,263 

Sunday,  May  26th 6.014 

Total  Attendance 67,507 

Number  of  Infants  Cared  for  in   Mothers'   Rest  Room,   Horticultural 

Hall,  May  18th  to  26th 

Saturday,  May  18, 1912 22 

Sunday,  May  19th                                      30 

Monday,  May  20th .  .                             110 

Tuesday,  May  21st 150 

Wednesday,  May  '2'2,1 210 

Thursday,  May  23d 350 

Friday,  May  2'4th 280 

Saturday,  May  25th 316 

Sunday.  May  26th 265 

Totiil 1,733 

Total  Attendance  at  Subsidiary  Shows 

Down-town  Subsidiary  Show 22,345 

Kensington  Subsidiary  Show 6,216 

Germantown  Subsidiary  Show 4,823 

Manayunk  Subsidiary  Show 6,902 

Total  Number  of  Visitors  to  Subsidiary  Shows 40,286 

Total  Number  of  N'isitors  at  Horticultural  Hall 67,507 

Total  Number  of  Visitors  to  both  Main  Exhibit  and  Subsidiary  Shows 107,793 


Committees  and  Organization 


COMMITTEES  AND  ORGANIZATION 

OFFICERS 

Honorary  Chairman,  Hon.  Rudolph  Blankenbubg 
Chairman,  Dr.  Joseph  S.  Neff 
Treasurer,  Me.  Edwahd  T.  Stotesbuby 
Secretary,  Dr.  Howahd  Childs  Carpenter 
Executive  Secretary,  Mr.  Kahl  de  Schwedjitz 

EXECUTIVE  COMMITTEE 

Mrs.  R.  R.  Porter  Bradford  Mr.  James  S.  Hiatt 

Dr.  Jesse  D.  Burks  Dr.  Henry  D.  Jump 

Dr.  Howard  Childs  Carpenter  Miss  Margaret  Lehmann 

Dr.  Charles  A.  Fife  Dr.  Jo.seph  S.  Xeff 

Dr.  Lawrence  F.  Fhck  Dr.  W  illiain  Duffield  Robinson 

Mrs.  \V.  W.  Frazier  Mr.  Edwin  D.  Solenbcrgcr 

Dr.  C.  Lincoln  Furbush  Mr.  K.  T.  Stote.sliury 

Dr.  Samuel  McClintook  Ilamill  Mrs.  TaleoU  Williams 

Dr.  Charles  J.  Hatfield  Mr.  Alexander  M.  Wilson 

committp:e  of  fixanx  e 

Dr.  Lawrence  F.  Flick,  Chairman 

Mr.  Edward  Ames  Ballard  Mr.  F.  O.  Harris 

Mr.  Edward  Bok  Dr.  Charles  J.  Hatfield 

Mr.  George  Burnham,  Jr.  Mr.  Alba  B.  Johnson 

Mr.  J.  Carstairs  Dr.  Henry  D.  Jump 

Mr.  Samuel  Castner,  Jr.  Mr.  Louis  C.  Madeira 

Mr.  Fred  T.  Chandler  Mr.  J.  \'aughan  Merrick 

Mr.  C.  H.  Clark,  Jr.  Mr.  Randal  Morgan 

Mr.  E.  W.  Clark  Mr.  Arthur  E.  Xewbold 

Mr.  Francis  R.  Cope,  Jr.  Mr.  Clement  B.  Xewbold 

Mr.  Cyrus  H.  K.  Curtis  Mr.  S.  Davis  Page 

Mr.  James  M.  Dodge  Mr.  Harold  Peirce 

Mr.  George  W.  Elkins  Mr.  P.  M.  Sharpless 

Mr.  W.  W.  Frazier  Mr.  Philip  L.  Spalding 

Mr.  Lincoln  Godfrey  Mr.  E.  T.  Stotesbury 

Mr.  John  Gribbel  Mr.  S.  M.  Vauclain 

Dr.  Samuel  McClintock  Hamill  Mr.  Stuart  Wood 

COMMITTEE  OX  GEXERAL  ARRANGEMENTS 

Dr.  Henry  D.  Jump,  Chairman 
Mr.  Charles  L.  Chute,  Secretary 

Dr.  Howard  Childs  Carpenter  Dr.  Howard  Kennedy  Hill 

Dr.  Charles  A.  E.  Codman  Dr.  Edward  Z.  Holt 

Dr.  J.  Clinton  Foltz  Miss  Mary  Ingham 

Dr.  A.  P.  Francine  Dr.  Theodore  Le  Boutillier 

Dr.  C.  Lincoln  Furbush  Dr.  William  Duffield  Robinson 

Dr.  C.  H.  Gray  Dr.  John  F.  Roderer 

Dr.  Charles  J.  Hatfield  Dr.  John  F.  Sinclair 

167 


168       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


COMMITTEE  ON  PROCURING  EXHIBITS 

Dr.  Charles  A.  Fife,  Chairman 

Dr.  Howard  Kennedy  Hill,  Secretary 


Mr.  George  \\'.  Atherholt 

Miss  Ellen  C.  Babbitt 

Dr.  E.  P.  Barnard 

Dr.  J.  P.  Bethel 

Dr.  William  N.  Bradley 

Mr.  J.  B.  Byall 

Dr.  A.  A.  Cairns 

Dr.  J.  B.  Carnett 

Dr.  Howard  Childs  Carpenter 

Dr.  Paul  B.  Cassidy 

Dr.  W.  S.  Cornell 

Dr.  Morris  Cornfeld 

Dr.  Frank  A.  Craig 

Dr.  Ale.x.  Heron  Davisson 

Dr.  Frank  D.  Dickson 

Dr.  C.  B.  Farr 

Dr.  Lawrence  F.  Flick 

Dr.  Frederick  Fraley 

Miss  Hannah  Fox 

Dr.  C.  Lincoln  Furbush 

Dr.  M.  H.  Fussell 

Dr.  J.  C.  Gittings 

Dr.  Samuel  McClintock  Hamill 

Dr.  Charles  J.  Hatfield 

Dr.  Bailey  Herman 

Dr.  Barton  Cooke  Hirst 

Dr.  John  Cooke  Hirst 

Dr.  E.  Z.  Holt 

Dr.  Francis  B.  Jacobs 

Dr.  Charles  F.  Judson 

Dr.  Alexander  Klein 

Dr.  Norman  L.  Knipe 

Dr.  Frank  Crozer  Knowles 

Dr.  Edward  Bell  Knnnbhaar 

Dr.  H.  R.  M.  Landis 


Mr.  Porter  R.  Lee 
Miss  Margaret  Lehmann 
Dr.  Theodore  Le  Boutillier 
Dr.  Bertha  Lewis 
Dr.  C.  J.  Marshall 
Dr.  Robert  S.  McCombs 
Mrs.  R.  Tait  McKenzie 
Miss  Ella  Michael 
Dr.  D.  J.  M.  Miller 
Dr.  Charles  M.  Montgomery 
Dr.  Arthur  Newlin 
Mr.  Bernard  J.  Newman 
Dr.  S.  W.  Newmayer 
Dr.  Percival  Nicholson 
Dr.  Richard  C.  Norris 
Dr.  Maurice  Ostheimer 
Miss  Helen  L.  Parrish 
Miss  Charlotte  Perkins 
Dr.  Robert  L.  Pittfield 
Dr.  C.  S.  Raue 
Dr.  W.  T.  Rees 
Miss  Nellie  M.  Rennyson 
Dr.  Sidney  J.  Repplier 
Dr.  John  F.  Sinclair 
Dr.  Frances  R.  Sprague 
Dr.  A.  H.  Stewart 
Dr.  Alice  W.  Tallant 
Dr.  Marianna  Taylor 
Mr.  John  A.  Vogleson 
Mr.  Roy  .Smith  Wallace 
Dr.  Jolm  K.  Walker 
Dr.  Joseph  Walsh 
Dr.  C.  H.  Weber 
Dr.  T.  C.  Westcott 
Dr.  C.  Y.  White 
Dr.  S.  S.  Woody 


COMMITTEE  ON  LECTURES  AND  DEMONSTRATIONS 
Dr.  Samuel  McClintock  Hamill,  Chairman 


Dr.  Howard  Childs  Carpenter 
Dr.  Ward  Brinton 
Mr.  William  B.  Buck 
Dr.  J.  Claxton  Gittings 
Dr.  Alfred  Hand,  Jr. 
Dr.  Charles  J.  Hatfield 


Dr.  H.  R.  M.  Landis 
Mrs.  R.  Tait  McKenzie 
Dr.  Theodore  Le  Boutillier 
Dr.  Maurice  Ostheimer 
Dr.  J.  Torrence  Rugh 


COMMITTEE  ON  PUBLICITY 

Dr.  William  DufEeld  Robinson,  Chairman 


Dr.  J.  B.  Carnett 
Dr.  C.  H.  Gray 
Dr.  L.  J.  Hammond 


Dr.  Isaac  Leopold 

Dr.  Theodore  Le  Boutillier 

Mr.  W.  T.  Rawson 


COMMITTEES  AND  ORGANIZATION 


169 


COMMITTEE  OX  EDITATIOX 

Mr.  James  S.  Hiatt,  Chairman 


Dr.  Jesse  D.  Burks 
Mr.  Edwin  S.  Solenberger 
Miss  Margaret  H.  Lehmann 
Miss  Helen  M.  Glenn 
Mrs.  Martha  J.  Magee 
Mrs.  L.  M.  Roberts 
Mr.  Richard  \\'aterman 
Dr.  E.  E.  Graham 


Dr.  J.  P.  Crozer  Griffith 

Dr.  Alfred  Hand,  Jr. 

Dr.  C.  F.  Judson 

Dr.  Walter  S.  Cornell 

Dr.  Howard  Childs  Carpenter 

Dr.  George  \V.  Flounders 

Mrs.  Edwin  C.  Grice 


Mr.  Joseph  liartilurci 
Mrs.  R.  R.  P.  Itradford 
Mr.  Jo.seph  Di  Silvestro 
Rev.  J.  P.  Duffy 
Rev.  H.  L.  Duliring 
Mr.  John  T.  Enilen 
Mr.  Thomas  S.  Evans 
Mrs.  W.  W.  Frazier 
Rev.  Carl  E.  Grammer 
Mrs.  Edwin  C.  Grice 


COMMirrEE  ox  SOCIAL  ORGAXI/.ATIOXS 
Mr.  Alexander  M.  Wilson,  Chairman 
Mr.  J.  Bruce  Byall,  Secretary 

Mr.  James  J.  Hickey 
Mr.  Porter  R.  Lee 
Miss  Margaret  H.  Lehmann 
Rabbi  H.  L.  Leventhal 
Mrs.  Louis  C.  Madeira 
Miss  Katherine  Melley 
Mi.ss  Laura  .\.  I'latt 
Miss  Florence  L.  Sanville 
Mr.  Edwin  B.  Solenberger 
Mr.  Rov  Smith  Wallace 
Mr.  Charles  T.  W  alker 


COMMITTEE  OX  P.VTROXESSES  AXD  AIDES 

Mr,s.  Talcott  Williani.s,  Chairman 

Miss  Gertrude  II.  Leidy,  Secretary 

Mrs.  Cyrus  Adler  Mrs.  William  M.  Kerr 

Mrs.  Rudolph  Hlankenburg  Mrs.  R.  Tait  McKenzie 

Mrs.  Jasper  Y.  Brinton  Mrs.  James  P.  MeXichol 

Mrs.  Edward  P.  Da\is  Mrs.  Joseph  S.  Xeff 

Miss  Henrietta  B.  Ely  Mrs.  George  Wharton  Pepper 

Mrs.  Chancellor  C.  English  Mrs.  Lewis  S.  Somers 

Mrs.  Edward  B.  Finck  Mrs.  Edward  T.  Stotesbury 

Mrs.  W.  AV.  P'razier  Miss  Frances  A.  Wister 

Mrs.  Edward  C.  Grice  Mrs.  Owen  Wister 
Mrs.  William  F.  Jenks 


COMMITTEE  OX  PUBLICATIOX 

Dr.  C.  Lincoln  Furbush,  Chairman 

Dr.  Samuel  McClintock  Hamill  Mr.  Karl  de  Schweinitz 

Miss  Ellen  C.  Babbitt 


Financial  Statement 


13 


FINANCIAL  STATEMENT 

Expenditures 

1.  Salaries  and  honoraria  (including  lecturers,  demonstrators,  stenographers, 

office-boys,  engineers,  attendants,  etc.) $i,452.iil 

2.  Printing,  stationery,  rent  of  typewriters,  telephone  and  telegraph,  ofiBce 

supplies,  carfare,  etc 2,116.71 

3.  Postage .561.90 

4.  Advertising 1,553.78 

5.  Rent  and  in.surance 1,267.75 

6.  Main  exhibit  (including  preparation  of  building  and  installation  of  exhibits, 

signs,  decorations,  burlap,  electrical  lighting,  plumbing  equipment, 
special  installation,  heat,  light  and  power,  drawing.s,  blue  prints,  charts, 
stereopticon  an<l  lantern  .slides,  moving  picture  machine  and  films 3,452.16 

7.  Subsidiary  Exhibits  (including  plumbing  equipment,  special    installation. 

heat,  light  and  power,  preparation  of  building  and  installation  of  ex- 
hibits, signs,  decorations) 607.93 

8.  Freight,  expres.sage,  and  hauling 107.97 

9.  Movingexhjbit 257.50 

10.  Miscellaneous  (including  disbursements  for  chairs,  ice,  repairs,  hardware, 

materials,  etc.) 606.37 

11.  Printing  report 1,600.00 

Total  expenditures $14,704.34 

Receipts 

Subscriptions $  2,379.2,S 

Appropriation  from  Councils 5,000.00 


$  7,379.23 
Balance  due  from  guarantors $  7,325.11 


Through  the  kindness  of  Mr.  J.  T.  BjTne,  of  the  Bureau  of  Municipal  Research, 
who  contributed  his  ser\'ices,  tlie  accounts  have  been  duly  audited  and  found  correct. 


173 


174       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


GUARANTORS 


1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 
29. 
30. 
31. 
32. 
33. 


A  friend  of  the  Show 

34. 

Mr. 

Eli  B.  Hallowell 

Dr.  Thomas  G.  Ashton 

35. 

Mr. 

J.  G.  Harris 

Mr.  Richard  L.  Austin 

36. 

Mr. 

.\lfred  C.  Harrison 

Mr.  Francis  W.  Ayer 

37. 

Mr. 

Franklin  S.  Horn 

Mr.  Ellis  Ames  Ballard 

38. 

Mr. 

Samuel  F.  Houston 

Mr.  H.  R.  Baltz 

39. 

Mr. 

Alba  B.  Johnson 

Miss  Harriet  Blanchard 

40. 

Mr. 

John  D.  Johnson 

Mr.  Edward  Bok 

41. 

Mr. 

Lawrence  McCormick 

Mrs.  Edward  Bok 

42. 

Mr. 

George  H.  McFadden 

The  Henry  Bower  Chemical  Mfg.  Co. 

43. 

Mr. 

J.  Franklin  McFadden 

Mr.  George  Burnham,  Jr. 

44. 

Mr. 

William  L.  McLean 

Mr.  George  Burnham,  Sr. 

45. 

Mrs 

1.  James  P.  McNichol 

Mr.  W.  Atlee  Burpee 

46. 

Mr. 

Louis  C.  Madeira 

Mr.  J.  H.  Carstairs 

47. 

Mr. 

T.  E.  Mitten 

Mr.  E.  B.  Cassatt 

48. 

Mr. 

Randal  Morgan 

Mr.  Samuel  Castner,  Jr. 

49. 

Mr. 

Harrison  S.  Morris 

Mr.  Fred  T.  Chandler 

50. 

Mrs 

1.  Harrison  S.  Morris 

Mr.  C.  H.  Clark,  Jr. 

51. 

Mr. 

Arthur  E.  Newbold 

Mr.  E.  W.  Clark 

52. 

Mr. 

Clement  B.  Newbold 

Mr.  Herbert  L.  Clark 

53. 

Mr. 

S.  Davis  Page 

Mr.  S.  W.  Colton,  Jr. 

54. 

Mr. 

Richard  G.  Park 

Mr.  Cyrus  H.  K.  Curtis 

55. 

Mr. 

Frank  T.  Patterson 

Mr.  James  Mapes  Dodge 

56. 

Mr. 

Harold  Peirce 

Mr.  Chas.  J.  Eisenlohr 

57. 

Mr. 

Frank  C.  Roberts 

Mr.  0.  W.  Eisenlohr 

58. 

Mrs 

i.  Pedro  G.  Salom 

Mr.  George  W.  Elkins 

59. 

Mr. 

P.  M.  Sharpies 

Mr.  Theodore  N.  Ely 

60. 

Mr. 

Philip  L.  Spalding 

Mr.  Samuel  S.  Fels 

61. 

Mr. 

E.  T.  Stotesbury 

Mr.  W.  W.  Frazier 

62. 

Mr. 

Rodman  AVanamaker 

Mr.  Louis  Gerstley 

63. 

Mr. 

S.  M.  Vauclain 

Mr.  Lincoln  Godfrey 

64. 

Mr. 

Robert  T.  Whitmer 

Mr.  Wm.  H.  Greene 

65. 

Mr 

.  George   Wood 

Mr.  John  Gribbel 

66. 

Mr. 

Stuart  Wood 

FINANCIAL  STATEMENT 


175 


CONTRIBUTORS 


Abernethy,  S.  C. 

Aertson,  Annie  D. 

Allen,  S.  L.,  and  Co. 

Amalgamated  Lace  Operatives  of  America 

Anders,  Dr.  J.  M. 

Asiiman,  W.  N. 

Bacharach,  Rebecca 

Barney,  Chas.  D. 

Barth,  Minna 

Bell,  Mrs.  \V.  Graham,  Washington,  D.  C. 

Bishop,  J.  V.  S. 

Bisler,  G.  A. 

Bisler,  G.  A.,  Inc. 

Borsch.  Henry  I'aul 

Boyd,  .Aiirelia  M. 

Brylawski,  Miss 

Burnham,  Mary  A. 

Caldwell,  Florence  F. 

Carstairs,  Mrs.  James 

Cartun,  Jacob 

Cash 

Cash 

Cash  Contributions 

Cash  from  sale  of  Drinking  Cups 

Clark,  C.  W. 

Converse,  John  \V. 

Cook,  M.  A.  H. 

Cox,  J.  L. 

Craig,  James 

Croft  &  Allen 

Cunningham,  Mrs.  E. 

Davidson,  \Vm.  G.,  &  Co.,  Inc. 

Davis,  Miss 

Davis,  A.  B. 

Davis,  Henry  L. 

Da\-is,  Miss  Mary 

DeArmond,  Mrs.  Geo.  J. 

DeCou,  Sarah  H. 

Derrick,  Mrs.  Alice  P. 

Dickson,  S.  S. 

Dilks,  Mrs.  Walter  Howard 

D'Invilliers.  Charles  E. 

Doan,  Chas.  R. 

Dobbins,  Murrell 

Eliel,  ^Irs.  Louis  S. 

Ely,  Harriet  B. 

Eshner,  Annette  F.  &  Juliet  F. 

Evans,  Eleanor  T. 

Evans,  George  B. 

Farr,  Mrs.  Wm.  W. 

Farran,  Wm.  J. 

Felton,  H.  B. 

Ferguson,  Margaret  M. 

Fuguet.  Mrs.  Stephen 

Fitch,  Jas.  E. 

Flagg.  Mrs.  Stanley  G..  Jr. 

Fliegelman,  Esther  K. 

Flick,  Dr.  Lawrence  F. 

Fo.\%  G.  Percy 

Friedberger,  Mrs.  H. 

Funk,  Miss  M.  L. 


Gallali,  Rudolph 

Garrett,  Mrs.  .\lfred  C. 

Gibbons,  Mrs.  Wm.  H. 

Graff,  Rev.  W.  11. 

Guckcr.  F.  T. 

Hadlev,  Mrs.  A.  P. 

Hallahan.  P.  T. 

Harbison,  Thos.  li. 

Harding,  Mrs.  .Mice  E. 

Harris.  .las.  Rus.sell 

Haughtim.  Richard 

Hay,  James 

Hcnkcnsiefaren.  J., A. 

Hesscnl)nich.  Mrs.  H. 

Hohlfcld  Mfg.  Co. 

Hollar,  Mrs.  Wm.  H. 

Horn,  Katharine  S. 

Howe,  M.  W.  F. 

Huey.  Malcolm  S. 

Huston,  Martha  Y. 

Hutchinson,  louden 

Hut(  liinson.  Mrs.  S.  E. 

Ingham,  Wm.  .\. 

Jenkins,  Chas.  F. 

Jenkins,  Mrs.  (Charles  Francis 

Jenk,s,  Helen  C. 

J.  K. 

J.  N.  M. 

Johnson,  Eldridge  R. 

.Joly.  Geo.  F.,  Jr. 

Jones,  Henry 

Jones,  James  Collins 

Judson,  Mrs.  O.  A. 

Justice,  Wm.  W. 

Kaighn,  Robt. 

Kendig,  Mrs.  Daniel 

Keyser,  Mrs.  Jas.  D. 

Kingston.  H.  H. 

Koch,  Mrs.  Andrew  P. 

Kohn.  Mrs.  David 

Kollner,  Josepliine 

Lane,  George 

Lang,  Sophie  F. 

Lea,  Charles  M. 

LeBoutillier,  Minnie  C. 

Leeds,  Sara  B. 

Leider,  Mrs.  Gertrude 

Levy,  Max 

Lewis,  Mrs.  .\nna  B. 

Lewis,  Edwin  H. 

Lenis,  John  F. 

Lewis,  Mrs.  John  Frederick 

Lewis.  Samuel  N. 

L.  H.  L. 

Lipman,  Mrs.  Bella 

Loos,  A.  J. 

Loucheim,  Mrs.  Joseph 

Lucearlin.  Mabel  E. 

Marsden,  Julia  Hebard 

Masland,  J.  Wesley 

McCauley,  Mrs.  S.  A. 


176       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


McCreary,  Geo.  D.,  Jr. 

McUhenny,  John  D. 

McPherson,  John  B. 

Meang,  Clara 

Merrick,  J.  Vaughan 

MiUer,  Clara  H. 

Mitchell,  Mary  Cadwallader 

Moore,  Mrs.  J.  C,  Jr. 

Morris,  Eliza  L. 

Morris,  Mrs.  F.  W. 

Morris,  Jane  Rhoads 

Netter,  Hilda  H. 

New  Century  Club 

Newlin,  Sarah 

Nicholson,  Mrs.  Wm.  R. 

Norris,  Geo.  W. 

Oliver,  The  V.,  Co. 

Payne,  Helena  A. 

Pennock,  Edward 

Petersen,  Otto  J. 

Petty,  J.  K. 

Phila.  Assn.  of  Day  Nurseries 

Phila.  Quartz  Co. 

Potter,  H.  Annie 

Powell  Knitting  Co. 

Randolph,  Mrs. 

Read,  Wm.  F. 

Reeves,  Francis  B.,  Jr. 

Reist,  Monroe 

Remmey,  Richard  C,  Sons  Co. 

Rhoads,  C.  J. 

Richardson,  Mrs.  C.  M. 

Ritchie,  Sarah 

Rosengarten,  Jos.  G. 

Rossmassler,  Bertha 

Rothwall,  Jane 

Ryan,  Thos.  J. 

Say  re,  John  C. 

Scattergood,  A.  G. 

Scattergood,  Mrs.  E.  S. 

Scattergood,  J.  Henry 

Scattergood,  Maria  C. 

Schloss,  Milton  J. 

Schreiner,  E.  T.,  M.D. 

Sheble,  Mrs.  Frank  J. 


Sheppard,  Mrs.  Margaret 

Sharp,  Eliz.  W. 

Sibley,  Mrs.  Edward  A. 

Sinnott,  Mrs.  Jos.  F. 

Sinnott,  Mary  E. 

Smith,  C.  Morton 

Smith,  Haseltine 

Smith,  F.  Conrad,  M.D. 

Smith,  VV.  Hinckle 

Snellenburg,  Samuel 

Snyder,  Ehrman  S. 

Somerville,  Anna  M. 

Spawn,  J.  N. 

Stafford,  Miss  B.  E. 

Steele,  Wm.,  &  Sons  Co. 

Stern,  Mrs.  Horace 

Stern,  Louis 

Stewardson,  Miss  M.  M. 

Strawbridge,  F.  H. 

Strawbridge,  Wm.  J. 

Strawbridge  &  Clothier 

Sundry  Cash  Contributions 

Sundry  Contributions 

Taylor,  Mrs.  Henry  P. 

Thomas,  Mrs.  Geo.  C. 

Tindle,  Rebecca  Knox 

Trexler,  S.  W.  C. 

Vauclain,  A.  C. 

Viener,  B. 

Walsh,  Jos. 

West,  Cornelius 

Westerman,  S.  A. 

Weston,  Mrs.  S.  Burn 

Whelan,  Thos.  J. 

W'hitcomb,  Mrs.  Chas.  Mortimer 

White,  S.  S.,  Dental  Mfg.  Co. 

Willcox,  James  M. 

Williams,  Ellis  D. 

Williamson,  Anna  J. 

Wister,  Mrs.  Owen 

Wohlschlagel,  J.  Fred 

Wolf,  Albert 

Woodward,  Miss  Eva  P. 

Wright,  T.  Howard 


Proceedings  of  Conference  on  Infant 

Hygiene 


Conference  on  Infant  Hygiene,  Held  in  the  Reception 
Room  of  the  Mayor  of  Philadelphia,  City  Hall 

First  Session— Wednesday,  May  22,  2.30  P.  M. 

Presiding  Officer: 

Mr.  Homer  Folks,  Secrelarv  of  the  State  Cliarities  Aid  Association,  of  Xew 
Yoriv. 

1.  Introductory  Remarks: 

Mr.  Homer  Folks. 

2.  Municipal  Child  Bureaus: 

Dr.  Josephine  Baker,  Direetor  of  Child  Hypiene,  Department  of  Health, 
New  York  City.  Discussion  to  he  opened  hy  Dr.  Jesse  D.  Burks,  Director 
of  the  Bureau  of  Municipal  Research,  of  Philadelphia. 

3.  Infant  Milk  Depots: 

Dr.  Rowland  G.  Freeman,  Adjunct  Professor  of  Pediatries,  University  and 
Bellevue  Hospital  Medical  School,  New  York.  Discussion  to  he  opened  by 
Dr.  William  C.  Woodward,  Health  Officer  of  the  Health  Department  of  the 
District  of  Columbia. 

4.  Social  Service  Work  in  Relation  to  the  Conservation  of  Child  Life: 

Dr.  Fritz  Talbot,  of  the  Department  of  Diseases  of  Children,  Medical 
Department  of  Harvard  University.  Discussion  to  be  opened  by  Miss 
Helen  M.  Glenn,  Head  Worker  of  the  Social  Service  Department  of  the 
University  Hospital  of  Philadelphia. 

5.  Home  Pl.\cing,  ^'ERsus  the  Institutional  Care  of  Babies: 

Dr.  H.  Hastings  Hart,  Director  of  the  Department  of  Child  Helping  of  The 
Russell  Sage  Foundation,  New  York.  Discus.sion  to  be  opened  by  Dr.  J. 
W.  Schereschewsky,  Director  of  the  Exhibition  of  the  15th  International 
Congress  of  Hygiene  and  Demography. 


Dr.  Samuel  McClintock  Hamill:  We  are  very  fortunate,  indeed,  in  hav- 
ing with  us  Mr.  Homer  Folks,  Secretary  of  the  State  Charities  Aid  Association  of 
New  York,  who  has  very  kindly  consented  to  preside  at  the  opening  session  of 
this  Conference.  Mr.  Folks'  active  interest  in  one  phase  of  the  work  among 
infants,  and  his  general  interest  in  every  department  of  that  work,  is  well  known 
to  you  all.  These  and  his  many  other  interests  keep  him  so  fully  occupied  that 
I  know  he  has  sacrificed  much  to  come  here.  It  is,  therefore,  with  sincere  appre- 
ciation, as  well  as  pleasure,  that  I  introduce  Mr.  Folks  to  this  audience. 

179 


180       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


ADDRESS  OF  MR.  HOMER  FOLKS 


I  could  not  resist  the  temptation  to  take  some  part  in  a  Baby  Saving  Show 
and  a  conference  connected  therewith.  It  must  be  a  very  small  part,  because 
in  the  course  of  the  afternoon  we  have  eight  stated  speakers  and  any  quantity 
of  discussion,  so  that  it  falls  to  me  simply  to  open  the  subject  as  briefly  as  may  be. 

I  was  highly  pleased  to  see  that  you  gave  yourselves  the  title  which  the  New 
York  Evening  Post  has  referred  to  as  "undignified,  but  very  happy" — Baby 
Saving  Show.  All  my  experience  indicates  that  there  is  a  great  difference  between 
infants  and  babies.  We  usually  talk  about  infants  and  infant  mortality.  I 
think  you  are  very  much  wiser  in  talking  about  "babies"  and  in  giving  the  babies 
a  show.  The  difference  between  infants  and  babies  is  the  difference  between 
the  academic  and  the  vernacular,  between  the  uninteresting  and  the  interesting. 
There  are  exceptional  men  who,  perhaps,  would  risk  their  lives  to  save  an  infant, 
but  there  is  no  man  who  would  not  instantly  risk  his  life  to  save  a  baby.  It  seems 
natural  that  some  dignified  infants  should  die,  pity  though  it  be!  but  the  death 
of  a  baby  is  always  tragic  and  always  enlists  our  sympathy  to  the  utmost  degree. 
I  was  glad  to  be  invited  to  a  show,  not  an  exposition  nor  an  exhibition,  nor  any 
other  learned  affair.  People  like  to  go  to  a  show,  but  must  be  wheedled  into 
going  to  an  exhibition.  I  was  also  glad  that  the  babies  were  not  to  be  conserved 
or  protected,  but  just  merely  saved — the  good  old  short  word.  Everybody  under- 
stands what  saving  babies  is.  It  would  be  rather  difficult,  I  think,  to  interest 
the  city  authorities  in  a  large  way  to  devote  sums  of  money  to  the  protection  of 
infants,  but  I  am  perfectly  sure  that  the  appeal  for  saving  babies  would  be  irre- 
sistible, and  that  a  municipal  organization  to  save  babies  could  always  get  ade- 
quate support. 

Having  gotten  into  the  vernacular  in  the  baby  saving  show,  I  wish  to  point 
out,  in  opening,  only  two  aspects  of  the  subject  in  which  I  hope  you  have  stuck 
to  the  vernacular  and  the  simple  straightforward,  old-fashioned  words.  The 
first  point  which  has  occurred  to  me  in  connection  with  meetings  for  the  preven- 
tion of  infant  mortality,  and  in  connection  with  the  work  of  most  of  the  agencies 
which  we  set  on  foot  for  the  saving  of  infants'  lives,  is  this:  that  possibly  we  are 
still  a  little  too  dignified  to  say  as  much  as  we  ought  to  say  about  nursing  babies. 
All  my  experience  in  the  care  of  babies, — and  I  have  had  quite  a  little  experience 
in  the  care  of  foundlings  and  babies  separated  from  their  mothers, — all  that  has 
led  me  to  see  that  so  far  as  food  is  concerned  no  artificial  feeding  whatever  can 
take  the  place  of  wet-nursing;  and  if  the  baby  must  be  separated  from  its  mother, 
or  has  been  separated,  then  its  greatest  chance  of  life  is  to  be  wet-nursed  by  some 
other  mother  who  has  lost  her  own  baby.  I  think  there  is  real  danger  that  in 
our  campaigns  and  discussions  and  meetings  about  milk  stations,  and  so  on,  we 
may  convey  to  the  public  mind,  quite  unintentionally,  the  impression  that  by 
getting  a  pure  milk  supply,  or  approximately  so,  we  shall  save  the  babies.     Now, 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       181 

I  have  no  impression  at  all  that  that  will  be  the  case,  and  I  am  firmly  convinced,  and 
I  believe  we  all  are,  that  the  greatest  single  step  forward  that  could  be  taken 
would  be  to  secure  the  largest  degree  of  nursing  of  babies  by  their  own  mothers; 
and,  therefore,  I  hope  that  in  this  baby  saving  show  and  the  meetings  connected 
with  it  we  shall  not  fail  to  make  clear  to  the  general  public,  as  I  believe  it  is  clear 
to  all  of  us,  that  in  discussing  pure  milk  and  milk  stations,  and  all  those  accessories, 
we  do  not  wish  to  lose  sight  for  a  moment  of  the  paramount  inii)ortance  of  the 
nursing  of  children  by  their  own  mothers  in  all  suitable  cases.  Of  course,  there 
are  exceptions. 

The  second  suggestion  which  I  wish  to  make  is  that  some  of  us  social  workers 
and  our  charitable  agencies  jiromote  and  i)crhai)s  produce  a  substantial  part  of 
the  ])roblems  of  infant  mortahty.  It  is  hard  enough  to  deal  with  those  aspects 
of  the  problem  that  are  thrust  upon  us,  with  conditions  that  are  beyond  our  im- 
mediate control.  It  certainly  would  be  a  j)ity  if  we  deliberately  and  l>y  intent 
voluntarily  increased  the  prosjjccts  of  infant  mortality.  And  yet,  over  in  New 
York,  to  a  much  less  extent,  I  am  glad  to  say,  in  Philadelphia,  but  to  some  extent 
in  all  large  cities,  we  do  deliberately  do  things  which  greatly  increase  the  certainty 
that  a  large  number  of  infants  will  lose  their  lives.  The  thing  I  have  in  mind 
is  the  ready  separation  of  the  young  baby  from  its  mother.  We  do  that  par- 
ticularly when  the  child  hajipens  to  be  born  out  of  wedlock.  I  have  forgotten 
how  many  hundreds  of  children,  but  a  great  many  hundreds  of  babies  in  New 
York, — some  two  thousand  every  year,  I  think, — are  taken  from  their  mothers 
voluntarily,  and  in  the  name  of  charity,  for  the  sake  very  often  of  endeavoring 
to  protect  the  reputation  of  the  mothers'  parents.  A  long  series  of  efforts  in 
the  care  of  such  children  shows  that  when  that  is  done,  under  the  best  of  cir- 
cumstances, thus  far  about  50  per  cent,  of  these  babies  do  not  live  to  be  two  years 
of  age.  So  we  do  enormously  increase  the  probability  of  fatality  by  separating 
the  young  infant  from  its  own  mother.  I  have  come  to  the  conclusion  that  if 
we  persist  in  our  mistaken  charity  on  that  scale  and  in  that  manner,  we  should 
be  brought  up  by  the  law,  and  just  as  it  is  an  offense  against  the  law  to  abandon 
a  child  on  the  street  or  in  the  park  or  other  place,  it  should  be  as  much  an  offense, 
except  under  exceptional  circumstances,  to  abandon  an  infant  to  the  care  of  a 
so-called  charitable  organization. 

These  two  aspects  of  the  subject  contribute,  it  seems  to  me,  to  an  unrecog- 
nized degree,  to  the  magnitude  of  the  infant  mortality  problem.  If  we,  as  social 
workers  and  charitable  agencies  and  lying-in  hospitals,  will  but  revise  our  methods 
and  adjust  our  work  wiih  what  we  know  to  be  the  facts,  we  shall  very  materially 
reduce  the  problem  presented  to  the  health  authorities  and  the  voluntary  charita- 
ble agencies,  to  bring  it  within  workable  measure. 

There  is  one  bureau  in  the  government  of  New  York  City  (which  has  a  very 
elaborate  and  comphcated  array  of  bureaus)  in  which  everybody  believes,  which 
everybody  believes  to  be  doing  exceedingly  valuable  work:  it  is  the  Bureau  of 
Child  Hygiene.  If  the  great  Health  Department  of  New  York  City  did  nothing 
else  but  carry  on  that  Bureau  its  entire  expense  would  be  amply  justified.     It  is 


182       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

a  particular  pleasure  to  introduce  to  you  the  very  efficient  Director  of  the  Bureau 
of  Child  Hygiene  of  New  York  City,  Dr.  S.  Josephine  Baker,  who  will  speak  on 
the  subject  of  "Municipal  Child  Bureaus." 


MUNICIPAL  CHILD  BUREAUS* 
BY  S.  JOSEPHINE  BAKER,  M.D. 

Director  of  Child  Hygiene,  Department  of  Health,  City  of  New  York 


Hoffman  has  stated,  in  his  work  on  "The  Sphere  of  the  State,"  that  "that 
is  not  the  best  government  which  governs  the  least,  but,  on  the  contrary,  that 
which  enters  most  deeply  into  the  real  needs  and  daily  interests  of  its  subjects," 
and,  further,  "the  ultimate  responsibility  for  the  child  is  with  the  State,  and  it 
should  spare  no  means  to  make  the  child  as  useful  a  member  of  the  State  as  the 
capabilities  of  the  child  and  the  given  circumstances  permit." 

Over  one  hundred  years  ago  the  State,  through  its  power  of  government, 
recognized  this  responsibility  by  deciding  that  a  citizen,  to  be  useful,  must  be 
literate,  and  for  this  purpose  established  its  system  of  free  public  education.  To- 
day the  State  is  recognizing  that  a  citizen,  to  be  useful,  must  be  healthy,  and  in 
acting  upon  this  principle  has  ultimately  come  to  the  realization  that  preventive 
health  work  among  children  offers  a  vast  field  of  potential  possibilities,  not  only 
in  the  prolongation  of  life,  with  a  decreased  death-rate,  but  in  the  greater  efficiency 
of  those  who  live,  with  correspondingly  decreased  poverty,  delinquency  and 
dependency.  Modern  sanitary  science  seeks  to  counteract  those  conditions 
which  further  the  development  of  the  so-called  "preventable  diseases."  As 
life,  measured  by  the  years  of  its  normal  duration,  approaches  and  passes  its 
meridian,  the  preventable  diseases  decrease  in  the  frequency  of  their  occurrence. 
Approximately  one-fifth  of  all  deaths  at  all  ages  occur  during  the  first  five  years 
of  life.  At  least  one-half  of  these  are  preventable.  The  deaths  from  infectious 
diseases  are  mainly  encountered  between  five  and  fifteen  years  of  age,  while  tuber- 
culosis, which  causes  more  deaths  than  any  other  single  disease,  is  mainly  dependent 
upon  a  lack  of  natural  or  acquired  resistance,  and  it  is  probable  that  this  latent 
tendency  has  its  inception  during  the  period  of  childhood.  The  effort  to  eliminate 
tuberculosis  will  be  successful  only  in  proportion  to  the  recognition  of  this  knowl- 
edge, for  public  health  work  among  children  offers  a  solution  of  the  tuberculosis 
problem  in  the  only  way  it  will  ever  be  solved,  and  that  is  by  primarily  preventive 
measures. 

The  vast  alien  population  of  our  cities,  the  congestion  of  population,  economic 
strain,  and  lack  of  adjustment  in  living  conditions,  are  matters  which  must  cause 
us  the  greatest  concern,  for,  whatever  may  be  the  effect  upon  the  adult,  it  is  certain 

*  This  paper  has  been  slightly  modified,  but  in  all  essential  points  is  the  same  as  that  read  by 
me  before  the  Section  on  Public  Health  of  the  New  York  Medical  Society,  April  18,  1912. 


PROCEEDINGS  OF  COXFERENCE  ON  INFANT  HYGIENE        183 

that  it  in  no  way  approaches  the  serious  results  that  are  found  in  the  case  of  infants 
and  children,  born  in,  and  doomed  to  live  among,  surroundings  which  afford  them 
little  or  no  opportunity  for  a  normal,  sane,  or  healthy  life. 

Cities  in  themselves  are  causing  the  very  conditions  which  sanitarians  and 
social  workers  are  now  using  their  efforts  to  correct.  If  cities  produce  the  factors 
that  mean  excessive  infant  mortality  and  high  disease  incidence  among  children, 
the  cities  must  pay  the  cost  of  their  own  neglect,  and  as  a  measure  of  self-preser- 
vation bend  their  energies  towards  the  elimination  of  those  features  which  have 
caused  this  serious  and  wholly  deplorable  condition  of  affairs.  The  cost,  measured 
in  dollars  and  cents  alone,  may  seem  great  to  the  unobservant  aiul  to  those  un- 
familiar with  the  existing  status,  but  from  the  point  of  view  of  tiie  ])reservation 
of  the  State,  in  assuring  good  health  to  the  next  generation,  it  is  infinitesimal  and 
unworthy  of  consideration.  The  children  of  our  vast  alien  population  are  our 
real  American  citizens  in  the  making.  Keen,  intelligent,  actively  interested  in 
all  features  of  their  new  life,  they  furnish  a  never-ending  source  of  ins])iralion 
to  those  of  us  who  know  them,  and  work  through  and  among  them.  Not  only 
are  they  the  vulnerable  points  of  attack  in  educational  j)ublic  health  work,  but 
they  are  physically  the  material  itself  ui)on  which  the  force  of  [)ublic  health  work 
must  be  expended.  Their  future  value  to  themselves  and  to  the  nation  depends 
upon  their  knowledge  of  those  laws  which  make  for  j)hysical  and  mental  well- 
being.  Thus,  while  health  work  among  adults  nuist  be  largely  restrictive  and 
corrective,  and  often  disappointing  in  its  results,  public  health  work  among  and 
for  children  can  be  made  i)reventive  in  its  highest  meaning,  and  the  results  are 
well  worthy  of  all  the  time,  money  and  energy  expended  in  producing  them. 

In  line  with  these  principles  the  Department  of  Health  of  New  York  City 
organized  its  Division  of  Child  Hygiene  in  August,  1908.  This  division  has  a 
force  of  154  physicians,  265  trained  nurses,  33  nurses'  assistants,  30  clerks  and 
typists,  and  23  cleaners,  employed  during  the  entire  year,  and  an  additional  tem- 
porary force  of  56  trained  nurses  and  33  nurses'  assistants  employed  from  May 
1st  to  November  1st,  to  meet  the  extra  summer  work  in  the  infants'  milk  stations. 

Its  object  is  to  supervise  and  control  the  health  of  children  insofar  as  a 
municipal  health  department  may  accomplish  this  purpose.     Its  functions  include: 

1.  The  supervision  and  control  of  midwives. 

2.  The  instruction  of  mothers  in  the  care  of  babies  by — 

(a)     District  visiting. 
(6)     Infants'  milk  stations. 
(c)     Mothers'  conferences. 
{d)     Little  mothers'  leagues. 

3.  The  supervision  of  foundling  babies  boarded  in  private  homes. 

4.  The  sanitary  supervision  and  control  of  day  nurseries  and  institutions 
for  dependent  children. 

5.  The  medical  inspection  and  examination  of  school-children. 

6.  Vaccination  of  school-children. 

7.  The  issuing  of  employment  certificates  to  children  of  legal  working  age. 


184       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

A  question  which  has  never  been  decided,  and  which  probably  never  will  be, 
is  the  actual  money  value  of  a  human  life.  Court  decisions,  which  might  be  taken 
as  a  standard,  show  a  fluctuation  so  wide  that  no  standard  can  be  deduced.  The 
basis  has  usually  been  placed  upon  the  earning  capacity,  and  as  infants'  and  young 
children's  earning  capacity  is  rated  as  nil,  the  money  value  of  their  life  or  an 
estimate  of  their  future  productive  capacity,  based  upon  good  health,  is  exceedingly 
difficult  to  determine.  It  has,  however,  been  stated  many  times,  without  dispute, 
that  the  value  of  the  life  of  an  infant  under  one  year  of  age  is  $100.  With  this 
as  a  basis,  it  may  be  seen  that  15,000  infant  deaths  in  New  York  City  last  year 
alone  meant  a  money  loss  of  $1,500,000. 

In  its  efforts  to  reduce  infant  mortality  the  Department  of  Health  of  New 
York  City  has  made  a  strenuous  and  energetic  campaign  during  1!)11.  While  it 
is  not  possible  to  estimate  the  exact  number  of  lives  saved  which  may  be  charged 
with  any  degree  of  accuracy  to  the  credit  of  any  particular  organization  working 
in  this  field,  yet  from  the  point  of  view  of  the  city  and  its  expenditures  it  may 
readily  be  demonstrated  that  the  actual  cost  of  saving  the  baby's  life  is  con- 
siderably lower  than  the  loss  involved  in  allowing  it  to  die.  Some  few  years  ago 
the  New  York  Milk  Committee,  after  a  series  of  investigations,  stated  that  the 
average  cost  of  medical  attendance  and  funeral  services  for  each  baby  that  died  in 
New  York  City  was  $50.  During  1911  the  death-rate  among  infants  brought  to  the 
milk  stations  conducted  by  the  Department  of  Health  was  2.4  per  cent.;  in  the 
district  work  of  the  department  under  the  charge  of  the  visiting  nurses  the  death- 
rate  was  1.4  per  cent.  The  cost  of  this  service  amounted  to  about  two  dollars  a 
month  for  the  milk  station  baby,  and  about  sixty  cents  a  month  for  the  baljy  who 
was  cared  for  in  its  own  home.  The  total  reduction  in  infant  mortality  for  the 
year  in  actual  numbers  was  1183,  or  a  saving  in  dollars  and  cents  of  $118,300. 
Even  though  such  a  method  of  reasoning  may  be  used  to  prove  the  point  I  wish 
to  make,  yet  it  would  seem  unworthy  of  consideration  when  compared  with  the 
humanitarian  side  of  this  life  saving  project.  The  saving  in  human  anguish  alone 
cannot  be  computed,  and  the  conservation  of  life  means  more  to  the  state  than  the 
conservation  of  any  of  its  material  resources  can  ever  mean. 

The  exact  financial  value  of  the  medical  inspection  and  examination  of  the 
children  who  are  attending  our  public  schools  is  impossible  to  estimate.  It  has 
never  been  possible  to  determine  with  mathematical  accuracy  the  exact  number 
of  non-promotions  due  to  physical  defects,  or  the  influence  on  promotion  of  the 
medical  correction  of  these  defects.  Many  other  factors  must  be  considered,  as 
the  mental  equipment  of  the  child,  the  character  of  its  instruction,  the  idiosyn- 
crasies of  teachers  and  the  variability  of  the  methods  governing  promotions;  but 
that  the  physical  condition  of  the  child  bears  a  very  direct  relation  to  its  progress 
in  school  is  an  accepted  deduction  that  may  safely  be  made  as  a  result  of  the 
knowledge  we  already  have  upon  this  subject.  In  fact,  this  statement  is  almost 
superfluous,  as  it  is  a  matter  of  common  reasoning  that  a  sick  child  is  necessarily 
not  in  a  condition  either  to  attend  school  regularly  or  to  profit  by  the  instruction 
that  is  given  to  it. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       185 

In  New  York  City,  since  1908,  727,750  children  in  the  public  schools  have 
received  a  complete  physical  examination.  Of  this  number  an  average  of  40  per 
cent,  were  found  to  have  one  or  more  associated  physical  defects,  such  as  defective 
vision,  adenoid  growths,  enlarged  tonsils,  defective  nutrition,  pulmonary  or  cardiac 
disease,  ortho))edic  defects  and  tuberculous  glands,  with  or  witliout  the  most 
common  defect  that  we  find,  namely,  defective  teeth.  Thirty-five  per  cent, 
of  the  remainder  of  the  children  examined  were  found  to  have  defective  teeth  as 
the  only  physical  defect.  Such  a  condition  certainly  merits  consideration,  as  it  is 
quite  evident  that  these  defects  have  been  hitherto  unrecognized  and  untreated, 
and  that  it  is  the  duty  of  the  city,  in  order  to  protect  itself,  to  use  all  reasonable 
means  to  see  that  the  children  are  given  an  oi)|)ortunity  to  be  placed  in  normal 
physical  condition.  In  the  schools  alone  the  efforts  of  the  Division  of  Child 
Hygiene  have  resulted  in  an  immense  gain  in  school  time  for  those  children  who 
were  afTected  with  contagious  eye  and  skin  diseases,  the  neccssarj*  exclusions  from 
school  attendance  for  these  reasons  being  reduced  from  over  57,000  in  1903  to 
slightly  over  3,000  in  1911.  Of  the  children  who  were  found  to  have  physical 
defects  other  than  the  single  defect  of  teeth,  approximately  80  per  cent,  have  been 
placed  under  medical  care.  Our  experience  in  New  York  also  coinc'idcs  with  that 
of  all  other  communities  where  a  similar  system  of  supervision  of  the  health  of 
school-children  has  been  in  operation.  The  general  improvement  in  the  health 
and  cleanliness  of  the  child  and  the  home  hygienic  conditions  which  have  a  distinct 
bearing  upon  the  health  of  children  is  manifest  to  any  one  who  compares  the  status 
of  the  city  child  today  witli  that  obtaining  a  few  years  ago. 

One  objection  which  has  been  raised  by  the  medical  profession  in  regard  to 
this  work  should  not  pass  unnoticed.  It  has  been  alleged  that  the  a.ssumption, 
by  the  city,  of  the  responsibility  for  the  health  of  .school-children  has  made  serious 
inroads  upon  the  practice  and  income  of  private  physicians.  In  order  to  ascertain 
the  exact  conditions  in  relation  to  this  matter  I  have  had  tabulated  for  the  year 
1911  the  various  sources  from  which  children  have  received  treatment.  During 
that  year,  of  the  G5,150  children  treated,  37,986  (58  per  cent.)  were  treated  by 
private  physicians  or  dentists,  while  the  remaining  27,164  (42  per  cent.)  were 
under  the  care  of  hos]jitals  and  dispensaries.  An  absolute  rule  of  the  Department 
of  Health  is  that  no  child  shall  be  referred  to  an  institution  for  treatment  until  it 
has  been  definitely  ascertained  by  the  medical  inspector  or  nurse  that  the  family 
is  unable  to  pay  for  the  services  of  a  private  physician.  When  it  is  remembered 
that  the  defects  for  which  these  children  are  treated  are  those  for  which  no  treat- 
ment had  hitherto  been  received,  and  except  for  their  discovery  by  the  department 
would  remain  neglected,  it  may  readily  be  seen  that  the  department  is  turning 
over  each  year  to  the  physicians  of  the  city  thousands  of  cases  that  would  not 
have  come  to  them  under  other  circumstances. 

During  the  three  years  that  this  work  has  been  in  operation  there  has  been  a 
definite  decrease  in  the  percentage  of  the  number  of  individual  defects  found  each 
year,  with  the  exception  of  defective  teeth.  The  incidence  of  defective  vision 
has  decreased  from  13  per  cent,  in  1909  to  10  per  cent,  in  1911;    defective  nasal 


186       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

breathing,  which  implies  the  presence  of  adenoid  growths,  has  decreased  from  18 
per  cent,  in  1909  to  11  per  cent,  in  1911,  while  hypertrophied  tonsils  show  a  decrease 
from  22  per  cent,  to  15  per  cent,  in  the  same  space  of  time. 

This  work  in  the  schools,  with  its  control  of  the  contagious  disease  situation, 
with  the  elimination  of  the  school  as  the  main  focus  of  infection,  the  physical 
examination  of  each  child  as  soon  as  it  enters  school,  before  it  is  allowed  to  graduate, 
and  as  nearly  as  possible  every  two  years  in  the  interim,  the  instruction  of  the 
parents  in  the  character  of  defects  found,  and  in  the  necessity  for  treatment,  and 
the  follow-up  work  necessary  to  induce  parents  to  provide  treatment  or  to  record 
their  absolute  refusal  to  do  so,  was  performed  during  1911  at  a  per  capita  cost  of 
43  cents.  During  this  same  year  the  per  capita  cost  of  the  year's  schooling  in  the 
public  schools  of  New  York  city  was  $43.90. 

From  a  comparison  of  these  figures  and  facts  it  would  seem  that  one  had  a 
right  to  conclude  that  from  either  an  economic  or  humanitarian  point  of  view  the 
city  is  justified  in  its  expenditure  by  assuring  to  its  future  citizens  that  good  health 
which  means  virile  and  useful  man-  and  womanliood. 

The  State  has  a  wider  duty  in  this  matter,  however,  than  merely  to  consider 
the  health  of  the  child  in  its  relation  to  its  school  progress.  The  broad  and  vital 
questions  which  concern  the  health  of  the  next  generation  are  demanding  attention. 

In  child  hygiene,  as  it  is  viewed  by  the  New  York  City  Department  of  Health, 
is  implied  the  health  surroundings  and  conditions  of  the  child's  entire  life,  not 
merely  the  child  in  relation  to  any  one  jjhase  of  its  development,  nor  in  relation 
to  any  one  phase  of  its  life  in  or  outside  of  the  home,  but  the  child  itself,  from  birth 
to  puberty,  in  relation  to  all  the  circumstances,  conditions  and  incidents  which 
bear  upon  its  life  history  and  welfare.  The  health  of  the  child  to  its  fifth  year  has 
a  most  important  bearing  upon  its  health  between  the  fifth  and  fourteenth  years, 
which  is  the  school  age,  while  its  health  during  that  jjeriod  is  of  equal  importance 
in  determining  its  future  welfare.  Even  during  its  school  life  the  greater  part  of 
its  time  is  spent  in  the  home  or  under  influences  which  are  not  within  the  juris- 
diction of  the  school  authorities.  Systematic  and  continuous  oversight  during 
the  entire  life-cycle  of  the  child  is  essential  if  we  are  to  gain  a  well-rounded  child- 
hood. 

In  line  with  this  policy  the  division  includes  in  its  activities  the  control  of 
niidwives  who,  in  New  York  City,  report  about  40  per  cent,  of  the  total  number 
of  births.  The  supervision  and  licensing  of  these  women,  under  the  authority 
of  the  city,  since  the  organization  of  the  Division  of  Child  Hygiene,  has  resulted 
in  a  marked  improvement  in  their  methods,  and  consequently  in  the  health  of  the 
women  and  children  under  their  charge.  For  six  years  the  department  has  re- 
quired that  a  1  per  cent,  solution  of  silver  nitrate  be  used  by  midwives  as  a  pro- 
phylactic measure  for  the  prevention  of  ophthalmia  neonatorum.  The  midwives 
are  required  to  report  every  case  of  sore  eyes  occurring  in  their  practice,  and 
ophthalmologists  are  sent  in  each  instance  to  determine  if  true  ophthalmia 
neonatorum  is  present. 

For  many  years  the  statement  has  been  made  by  competent  persons  that 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       187 

one-quarter  of  all  persons  in  the  asylums  for  the  blind  were  there  as  a  result  of 
blindness  due  to  ophthalmia  neonatorum.  In  order  to  ascertain  the  result  of  the 
activity  of  the  department  in  this  regard,  a  searching  inquiry  was  made  during  the 
past  year  to  determine  the  present  status  of  these  cases.  Inquiry  was  made  of 
every  institution  for  the  blind  in  New  York  City  and  throughout  the  State  as  to 
the  number  of  children  under  observation  under  five  years  of  age,  born  in  New 
York  City,  and  blind  from  ophthalmia  neonatorum.  This  age  limit  was  taken 
as  covering  the  time  that  the  department's  efforts  might  reasonably  have  shown 
results.  Only  six  cases  were  reported  under  this  heading  from  all  of  the  institutions. 
The  Committee  on  the  Prevention  of  Blindness  of  the  New  York  Association 
for  the  Blind  stated  that  their  records  under  this  heading  showed  but  five  or  six 
children  of  five  years  or  under  l)lind  from  this  diseasea — total  of  twelve  cases  in 
the  entire  State.  In  this  point  alone,  in  decreased  human  suffering,  increased 
efficiency,  and  economic  independence,  the  gain  is  so  vast  that  it  cannot  be  com- 
pared with  the  insignificant  amount  of  money  expended  to  produce  such  results. 

The  facts  in  regard  to  puerperal  septicemia  are  also  worthy  of  comment. 
Every  death  that  occurs  in  New  York  City  from  this  disease  is  investigated  by 
the  department.  If  a  midwife  has  been  in  attendance  at  any  time,  even  for  a 
period  of  only  a  few  minutes,  the  case  is  listed  against  her  record,  and  is  classified 
as  one  in  which  a  midwife  was  in  attendance.  Notwithstanding  this  attitude, 
which  does  not  in  any  way  give  the  midwife  the  benefit  of  the  doubt,  it  has  been 
found  that  while  approximately  40  per  cent,  of  the  births  were  reported  by  mid- 
wives,  only  24  per  cent,  of  the  deaths  from  puerperal  septicemia  can  be  charged  to 
their  account,  while  physicians,  reporting  api)roximately  CO  per  cent,  of  the  births, 
were  in  attendance  at  the  time  of  confinement  in  the  case  of  70  per  cent,  of  the 
women  who  died  from  puerperal  septicemia. 

I  have  taken  a  few  isolated  instances  of  the  work  of  the  division  simply  to 
give  an  idea  of  some  of  the  directions  in  which  a  distinct  value  can  be  demonstrated. 
No  attempt  can  be  made,  however,  within  the  limits  of  this  paper,  to  cover  the 
many  features  of  the  work  which  are  daily  resulting  in  impro\'ed  health  and  physique 
to  the  children  of  the  city.  The  work  is  an  expression  of  the  new  relation  between 
boards  of  health  and  the  public.  It  is  not  paternalistic,  but  rather  social,  economic, 
and  humanitarian;  it  is  a  definite  recognition  of  the  value  of  educational  forces  as 
the  predominant  feature  in  modern  sanitary  methods.  Its  ultimate  object  is 
one  that  is  so  broadly  humanitarian  in  its  purposes,  and  so  stands  for  all  that  is 
idealistic  and  valuable  in  our  national  life,  that  we  may  well  agree  with  Croly, 
who  gives  expression  to  the  spirit  permeating  this  constructive  and  far-reaching 
effort  to  help  children  when  he  says:  "The  only  fruitful  promise  of  which  the  life 
of  any  individual  or  any  nation  can  be  possessed,  is  a  promise  determined  by  an 
ideal." 

Mr.  Folks:  I  am  sure  you  will  understand  now  what  I  said  about  the  esteem 
in  which  the  Department  of  Health  is  held  by  the  people  of  the  City  of  New  York. 

I  believe  that  the  Bureau  of  Municipal  Research  of  New  York  was  actively 
instrumental  in  securing  a  definite  organization  as  a  separate  Bureau  of  the  Depart- 

14 


188       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

ment  of  Health,  of  the  Bureau  of  Child  Hygiene.  The  discussion  of  the  general 
subject  introduced  by  Dr.  Baker  will  therefore  be  opened  very  appropriately  by 
Dr.  Jesse  D.  Burks,  the  Director  of  the  Bureau  of  Municipal  Research  in  Phila- 
delphia. It  is  desired  that  the  discussion  be  limited  to  infant  hygiene,  not  in  the 
narrowest  sense  of  the  term,  but  rather  covering  the  age  period  suggested  by  Dr. 
Baker.     I  have  great  pleasure  in  introducing  Dr.  Burks. 

DISCUSSION  ON  DR.  S.  JOSEPHINE  BAKER'S  PAPER 

Dr.  Jesse  D.  Burks:  Dr.  Baker  has  emphasized  the  advantage  and  importance  of  preventive 
•work  as  opposed  to  curative  or  palhative  work;  and,  by  way  of  illustration,  has  given  us  some  extremely 
pertinent  facts  regarding  preventable  conditions  among  cliildren,  especially  among  infants.  Assuming 
the  value  of  a  baby's  life  to  be  $100,  she  has  called  our  attention  to  certain  interesting  financial 
considerations,  which  indicate  that  New  'Vork  might  eliminate  an  annual  loss  of  .$1,500,000  by  saving 
1500  babies  every  year. 

To  my  mind,  while  such  an  argument  furnishes  a  more  or  less  striking  and  picturesque  social  appeal, 
it  is  clear  that  a  good  many  families  that  have  babies  could  figure  out  that  it  costs  them  a  good  deal 
more  to  bring  up  a  baby  than  it  does  to  bury  one.  The  economic  argument  doubtless  has  its  value,  but 
I  do  not  regard  this  as  the  most  effective  appeal  for  preventive  work.  We  are  all  willing  to  admit  that 
we  ought  to  save  the  babies  whether  it  costs  $50  or  $200  to  bury  one;  or  whether  it  costs  more  or  less 
to  save  a  baby  than  to  bury  it.  Dr.  Baker  may  have  foimd,  however,  that  the  men  who  appropriate 
money  for  public  purposes  are  influenced  by  the  economic  argument. 

Dr.  Baker  has  explained  the  favorable  effect  upon  school  children  of  the  medical  supervision  pro- 
vided by  the  Bureau  of  Child  Hygiene.  If  the  evidence  shows  that  the  health  of  school-children  is 
materially  bettered  by  the  work  of  medical  examiners,  we  have  a  very  substantial  reason  for  supporting 
a  bureau  of  child  hygiene.  It  is  obvious  that,  unless  the  750,000  children  in  New  York  public  schools, 
and  the  175,000  children  in  Philadelphia  public  schools,  are  in  physical  condition  to  get  from  the  school 
what  we  expect  them  to  get,  there  is  an  economic  and  educational  loss  not  only  to  the  children,  but  to 
the  community  which  is  supporting  the  school,  as  well  as  the  Bureau  of  Child  Hygiene. 

Dr.  Baker  then  came  to  what  she  regarded  as  the  fundamental  appeal;  that  is,  the  humanitarian 
appeal,  the  broad  social  interest  in  human  life  as  such,  which  lies  at  the  very  foundation  of  such  work 
as  the  Bureau  of  Child  Hygiene  is  doing.  She  brought  out  the  importance  of  a  new  relation  between 
the  health  authorities  and  the  community.  It  is  this  new  relationship  which  furnishes  the  key  to  the 
meaning  of  health  work  in  a  community;  that  is  really  at  the  bottom  of  what  we  are  trying  to  do  in  a 
Bureau  of  Child  Hygiene. 

I  want  to  emphasize  just  one  point  which  was  rather  assumed  than  brought  out  definitely  in  what 
Dr.  Baker  had  to  say.  One  of  the  stock  arguments  of  the  stand  patter  is  that  we  must  not  do  anything 
to  pauperize  the  people.  It  is  regarded  as  eminently  proper  to  build  automobile  roads  and  speedways 
for  the  use  of  those  who  use  automobiles  and  drive  fast  horses.  It  is  all  right  to  build  sewers  and  other 
public  works  which  everybody  must  use.  But  when  it  comes  to  furnishing  milk  and  ice  and  medical 
service  to  the  unfortunate  and  handicapped,  we  are  constantly  met  with  the  suggestion  that  we  must  not 
pauperize  the  people. 

Now,  we  went  through  exactly  such  a  stage  in  the  history  of  pubUc  education.  Public  schools 
were  inaugurated  as  pauper  schools;  and  there  were  undoubtedly  arguments  against  the  establishment 
of  public  schools  on  the  ground  that  we  must  not  pauperize  the  people;  that  people  should  pay  for  their 
education,  otherwise  they  would  not  deserve  or  appreciate  it.  This  last  argument,  of  course,  ceases  to 
have  force  when  tlirough  public  taxation,  everybody  gets  a  chance  to  pay  for  education. 

Education  advanced  through  the  pauper  school  stage,  and  the  time  came  when  the  schools  were 
not  only  public  but  were  generally  patronized.  Later  public  education  passed  through  even  this  second 
stage  and  reached  a  tliird  stage;  and  we  now  have  compulsory  education.  Public  schools  were  first 
for  paupers;   then  they  became  free  and  general;  and  now  have  become  general  and  compulsory. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE        189 

In  the  public  health  movement,  wliich  is  just  as  fundamental  a  matter  in  a  community  as  etliica- 
tion,  we  are  now  at  the  place  where  we  were  in  education  about  one  hundred  years  ago.  We  are  talk- 
ing about  pauperizing  the  people.  We  are  actually  providing  nurse  service  and  medical  ser%'ice  in 
most  of  our  communities,  largely  with  the  idea  of  taking  care  of  tlie  neglected  poor.  In  some  communi- 
ties, as  in  New  York  and  Philadeli)hia,  we  have  carried  the  public  health  program  somewhat  further; 
but  not  generally.  The  course  of  development  for  bureaus  of  child  hygiene  will  certainly  lead  us  to 
the  next  stage,  which  is  free  medical  service  and  free  nurse  service  for  all  children  whose  parents  call  for 
it.  Within  the  ne.xt  one  hundred  years,  possibly  the  next  fifty  years,  we  shall  get  to  the  point  of  fur- 
nishing medical  service  and  nurse  service  to  all  cliildren;  making  it  not  only  entirely  free,  and  free  from 
the  taint  of  pauperism,  but  compulsory.  It  will  be  an  absolute  requirement  of  the  community  that 
every  child  shall  submit  to  proper  inspection,  examination,  and  treatment  as  furnished  by  a  bureau  of 
child  liygiene.  We  are  already  coming  to  this  point,  in  the  inspection  of  school-children  for  contagious 
disease.  Indeed,  the  time  seems  to  be  rapidly  apiiroaching  when  a  bureau  of  child  hygiene  will  be 
regarded  as  a  fundamental  institution  just  as  important  to  the  community  as  the  public  school.  Five 
definite  divisions  or  branches  of  this  service  will  be  required: 

First,  there  must  be  a  division  of  medical  service,  strictly  speaking,  having  to  do  with  the  ex- 
amination, inspection,  and  treatment  of  children.  We  .shall  probably  find  that  the  preliminary  ex- 
amination of  pupils  for  defects  and  inspection  for  symptom.s  of  contagious  disease  can  be  done  by  nurses 
just  as  well,  if  not  better,  and  at  much  lower  cost,  than  by  physicians.  New  York  is  now  finding  this 
the  case.  It  has  recently  been  estimated  that,  by  employing  nurses  to  do  this  work,  most  of  which 
is  now  done  by  physicians.  New  York  can  save  at  least  $53,000  a  year. 

Second,  there  will  be  a  division  of  sanitation,  having  to  do  with  questions  of  school  sanitation  and 
home  sanitation.  This,  of  course,  is  not  necessarily  a  medical  function,  but  is  closely  related  to  this 
whole  problem  of  child  hygiene. 

Third,  there  will  be  a  division  of  hygiene  regvilation  of  the  children's  daily  activities  in  school  and 
at  home — largely  again  to  be  carried  on  by  intelligent  visiting  nurses. 

Fourth,  there  will  be  a  division  of  instruction  which  will  not  only  have  charge  of  the  instruction 
of  school-children  in  sanitation  and  hygiene,  but  the  instruction  of  mothers  in  homes  by  the  visiting 
nurses  and  supervising  physicians.  This  will  doubtless  include  the  much-debated  subject  of  sex  hygiene 
instruction. 

Fifth,  there  will  be  a  division  of  physical  education  which  will  supervise  the  physical  training  of 
children  at  school  and  may  include  adequate  supervision  and  physical  training  of  children  before  they 
come  into  schools  and  after  they  leave. 

These  tentative  proposals  are  submitted  in  the  hope  that  they  will  suggest  the  large  importance 
which  public  hygiene  and  sanitation  is  likely  to  assume  in  the  very  near  future. 

Mr.  Folks:  The  discussion  will  now  be  opened  for  a  few  moments  to  the  friends  who  care  to 
participate,  and  I  will  ask  them  kindly  to  state  their  names  as  they  arise.  Each  speaker  is  limited  to  at 
most  five  minutes. 

Mrs.  \Villhm  Lowell  Putnam,  Boston,  Mass.:  I  want  to  ask  Dr.  Baker  whether  the  doctors 
and  nurses  supervise  the  mid  wives? 

Ur.  Baker;  You  are  now  opening  a  very  large  question,  and  in  the  time  at  my  disposal  I  cannot 
take  care  of  it.  The  midwife  is  not  a  theory  at  all.  She  cannot  be  ignored.  She  is  here,  and  is  going 
to  exercise  her  functions  whether  we  license  her  or  not.  After  an  experience  of  three  years  with  midwives, 
as  we  have  them  regulated  in  New  Y'ork  City,  I  do  not  believe  in  ignoring  them  or  refusing  to  license 
them.  I  think  we  shoidd  carry  them  farther  than  we  have  by  giving  them  an  adequate  preliminary  educa- 
tion in  properly  equipped  schools.  In  the  State  of  Massachusetts,  if  I  am  not  mistaken,  the  law  does  not 
recognize  midwives,  and  yet  there  are  5000  or  6000  cases  delivered  by  midwives  each  year  in  Boston 
alone.  In  addition  to  this  number  of  reported  cases  there  is  also  probably  a  large  number  of  cases 
treated  by  them  which  are  not  reported,  because  they  are  under  no  supervision.  The  deaths  from 
puerperal  septicemia  which  occur  in  our  cities  cannot  be  attributed  solely  nor  in  greater  part  to  the 
midwives,  since  the  proportion  of  deaths  from  this  cause  among  cases  delivered  by  them  is  not  so  large 
as  is  the  proportion  of  deaths  in  the  cases  delivered  by  physicians.     As  I  stated  in  my  paper,  it  has  been 


190       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

found  that  while  approximately  40  per  cent,  of  the  births  were  reported  by  midwives  in  New  York,  only 
24  per  cent,  of  the  deaths  from  puerperal  septicemia  can  be  charged  to  their  account,  while  physicians 
reporting  60  per  cent,  of  the  births  were  in  attendance  at  the  time  of  confinement  in  the  case  of  76  per 
cent,  of  the  women  w  ho  died  from  this  cause. 

I  believe  that  existing  conditions  demand  that  midwives  receive  more  supervision  and  training 
than  they  are  getting  now,  but  I  do  not  believe  that  they  are  the  menace  to  the  public  health  that  many 
people  think.  I  am  convinced  that  the  question  of  the  employment  of  midwives  is  one  that  we  must 
meet  in  all  of  our  large  cities.  It  is  a  natural  and  legitimate  desire  on  the  part  of  the  women  of  the  poor 
to  want  midwives  to  attend  them,  since  the  midwife  gives  them  infinitely  more  for  their  money  than 
does  the  physician  who  treats  the  class  of  cases  now  cared  for  by  the  midwife.  We  have  established 
in  New  York  the  first  municipal  school  for  the  training  of  midwives  in  the  United  States.  It  is  under 
the  auspices  of  the  Bellevue  and  Allied  Hospitals,  and  directed  by  Dr.  Brown,  of  the  Bellevue  Hospital. 
I  wish  you  could  send  all  the  midwives  there  for  training. 

Dr.  W.  S.  Newmater,  Philadelpliia:  I  should  like  to  ask  Dr.  Baker  how  much  money  was  ap- 
propriated by  the  City  of  New  York  for  the  work  of  the  Department  of  Child  Hygiene  in  the  years  of 
1911  and  1912.? 

Dr.  Baker:  In  1911,  approximately  $390,000;  in  191i,  approximately  $600,000. 

Mr.  Folks:  That  is  not  paternalism,  yet  it  is  frequently  spoken  of  as  paternalism. 

Miss  Perkins,  Philadelphia:  What  are  the  duties  of  a  visiting  nurse  in  New  York? 

Dr.  Baker:  I  suppose  you  mean  with  relation  to  infant  mortality.  The  work  is  divided  into 
two  sections — that  of  the  milk  station  and  that  of  the  so-called  district  visiting.  We  have  one  nurse  in 
each  milk  station  and  we  have  55  milk  stations.  The  district  nurses  are  those  who  do  the  school  work 
in  winter.  Each  nurse  visits  150  babies  and  she  gets  to  them  each  at  least  once  in  ten  days.  She  re- 
ports to  the  central  office  every  day  the  exact  status  of  each  baby  visited,  so  that  the  central  office  is 
in  constant  touch  with  the  condition  of  the  entire  number  of  babies  under  supervision.  During  the 
past  year  these  nurses  at  their  visits  instructed  mothers  in  the  care  of  babies.  We  prefer  to  work  only 
with  the  well  babies,  turning  the  sick  over  to  some  other  agency.  Last  year  we  had  about  17,000  babies 
under  the  care  of  the  district  nurses. 

Mrs.  Cooper,  San  Francisco:  I  should  like  to  know  by  what  method  you  get  in  touch  with  the 
well  babies  in  New  York. 

Dr.  S.  Josephine  Baker:  We  have  the  birth  registry  and  the  records  sent  in  by  midwives  just 
as  soon  as  they  are  received  in  the  department.  The  names  are  copied  off  and  given  to  the  nurses, 
who  are  instructed  to  visit  them  at  the  earliest  opportunity,  which  is  certain  to  be  within  ten  days  of 
birth.  We  do  not  visit  any  babies  except  those  whose  births  are  reported  by  midwives,  although  should 
a  nurse  in  going  through  a  tenement  house  find  a  baby  in  a  family  which  is  not  able  to  maintain  a  doctor 
except  for  the  actual  confinement,  we  look  into  these  cases  also. 

Miss  Perkins,  Philadelphia:  I  would  like  to  speak  of  the  work  of  the  district  nurses  of  Phila- 
delphia. Their  work  is  probably  along  the  same  lines  as  that  of  the  New  York  nurses.  We,  too,  re- 
ceive some  early  reports  from  the  midwives,  and  such  cases  are  visited  within  twenty-four  hours  of  the 
time  at  which  the  report  is  received.  A  general  observation  is  made,  necessary  advice  is  given,  and  if 
any  such  condition  as  ophthalmia  neonatorum  is  discovered,  it  is,  of  course,  reported  at  once  to  the 
proper  medical  authorities.  With  our  eight  nurses  last  year  we  made  30,000  visits,  entering  more  than 
6000  homes. 

Mr.  Folks:  It  may  have  occurred  to  some  that  the  work  outUned  for  the  school-children  was 
very  advanced,  and  some  conservative  citizens  have  doubted  whether  it  was  wise  and  proper.  I  think 
they  would  be  reheved  and  encouraged  if  they  would  read  of  the  work  as  it  is  carried  on  very  much 
along  these  same  lines  in  Great  Britain  and  Germany.  You  will  find,  if  you  do  not  yet  happen  to  have 
read  it,  an  exceedingly  interesting  article  in  "The  Psychological  Clinic,"  published  by  the  University 
of  Pennsylvania,  in  either  February  or  March,  describing  that  work  fully,  and  telling  of  the  medical 
examination  of  school-children  in  certain  foreign  countries  and  the  operations  of  various  kinds.  This 
medical  work  is  carried  on  in  direct  connection  with  the  school  authorities,  and  the  work  is  carried  to 


PROCEEDINGS  OF  COXFEREXCE  OX  IXFAXT  IIYGIEXE       191 

its  logical  conclusion.  I  think  we  are  only  at  the  beginning  of  the  development  of  school  hygiene  work 
in  connection  with  our  children. 

Mrs.  Wilu.^m  Lowell  Putnam:  Have  you  no  institution.s  for  childbirths  in  New  York.' 

Dr.  B.vker:  There  are  several  lying-in  hospitals,  but  no  accurate  study  has  ever  been  made  of 
the  exact  amount  of  service  that  they  render  to  the  public.  A  superficial  study,  which  has  been  made, 
shows  clearly  that  they  are  not  at  all  adequate  to  the  needs  of  the  situation. 

Mrs.  Putn.^m:   Then  the  people  select  the  midvvives  instead  of  going  to  these  institutions? 

Dr.  B.\ker:  Yes,  we  cannot  reach  everybody  with  these  institutions.  Tliey  do  not  have  the 
capacity;   they  would  have  to  reach  abovit  75,000  cases  a  year  if  we  covered  the  whole  population. 

Mrs.  Putn.\m:  Then  you  select  the  midwivcs'  cases  for  your  visiting  nur.scs  because  you  think 
they  need  the  care  more.' 

Dr.  Baker:  Y'cs,  certainly.  Aside  from  this,  it  gives  us  the  opportunity  of  keeping  in  touch 
with  the  midwives. 

Mr.  Folks:  I  tliink,  now,  in  order  to  listen  to  all  the  papers,  if  there  is  no 
objection,  we  will  proceed  to  the  next  .sul)ject,  and  recur  to  this  if  we  have  time 
later  on.  The  next  paper  is  on  "Infant  Milk  Depots,"  by  Dr.  Rowland  G.  Free- 
man, member  of  the  Advisory  Board  of  the  New  York  Milk  Committee: 


INFANT  MILK  DEPOTS* 
BY  ROWLAND  GODFREY  FREEMAN,  M.D. 

Adjunct  Professor  of  Pediatrics,  University  and  Bellevue  Hospital  iledical  School,  \ew  York  City 


The  terrible  mortality  of  children  under  one  year  of  age,  who  are  for  the  most 
part  born  into  the  world  with  jierfect  organs  and  who  die  only  becau.se  they  are 
deprived  of  the  essential  conditions  of  good  health  in  infancy,  is  evidently  one 
that  can  and  .should  be  speedily  eliminated,  or,  at  least,  materially  reduced. 

This  mortality  has  been  a  matter  of  some  concern  for  many  years,  and  the 
attention  it  has  received  and  the  study  of  means  of  lessening  it  has  already  resulted 
in  cutting  it  down  about  one-half,  so  that  in  our  well-administered  cities  now, 
instead  of  finding  a  loss  of  one  child  in  every  three  during  the  first  year,  or  a  mortal- 
ity of  30  per  cent.,  such  as  existed  in  New  York  some  years  ago,  the  city  lo.ses  less 
than  one  child  in  every  six,  or,  to  be  more  accurate,  about  fourteen  in  every  hundred 
born. 

These  figures,  however,  scarcely  represent  the  terrible  mortality  among 
artificially  fed  children  among  the  tenements,  for  while  80  per  cent,  of  our  babies 
in  New  York  are  breast-fed  and  show  a  very  slight  mortality,  there  is  such  an  over- 
whelming mortality  among  the  20  per  cent,  of  artificially  fed  babies  as  to  bring 
the  mortality  of  the  whole  up  to  14  per  cent.  It  is  evident,  therefore,  that  the 
mortality  in  artificially  fed  babies,  which  is  unknown,  probably  represents  some- 

*The  cuts  accompanying  this  article  are  loaned  by  courtesy  of  .\rchives  of  Pediatrics,  in  the  Octo- 
ber, 1912,  issue  of  which  this  article  was  published. 


192 


REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


thing  like  70  per  cent.  It  would  seem,  then,  that  the  reduction  in  such  mortality 
is  not  so  much  a  matter  of  a  change  of  environment,  because  breast-fed  babies 
do  fairly  well  in  a  poor  environment,  as  it  is  a  matter  of  feeding. 

It  is  a  well-established  fact,  from  our  experience  in  institutions,  that  there 


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Fig.  1. — In  order  to  ascertain  the  efficiency  of  tbe  establishment  of  milk  depots,  the  mortality  in  the 
towns  ha\-ing  milk  depots  in  1904  was  compared  with  that  of  the  same  towns  in  the  year  1898,  and, 
as  seen  in  this  chart,  the  mortality  in  all  the  eleven  towns  containing  milk  depots  showed  some 
diminution. 


are  some  babies,  at  least  in  some  institutions,  who  cannot  be  brought  up  on  any 
artificial  food.  These  children  need  breast  milk,  and  if  our  institutions  could 
arrange  to  supply  a  moderate  amount  of  breast  milk  to  very  young  babies  that 
will  not  thrive  on  artificial  food,  their  mortality  would  be  greatly  reduced. 


PROCEEDINGS  OF  CO\FERE^'CE  OX  LXFAXT  IIVGIEXE       193 

Under  the  best  conditions  the  babies  are  very  rare  that  cannot  be  successfully 
fed  on  artificial  food,  and  wet-nurses  are  seldom  resorted  to  in  private  practice 
by  resourceful  pediatricians. 

In  private  practice,  where  few  babies  are  breast-fed,  and  then  only  for  the 


Fig.  i. — In  order  to  be  sure  that  this  was  not  due  to  other  conditions  than  the  milk  depots,  the  mortality 
in  the  same  year  of  these  eleven  towns  was  compared  with  eleven  neighboring  towns  in  w-hich  no 
milk  depots  were  established,  and  it  was  found  that  in  the  last  eleven  towns  there  was  an  invariable 
increase  in  mortality  in  VMi  over  1898. 


first  three  or  six  months,  not  one  in  150  dies  during  the  first  year,  as  against  the 
infant  mortahty  of  21  in  150  in  New  York  City.  So  that  this  enormous  mortality 
would  seem  theoretically  to  be  largely  controllable  by  supplying  these  babies  in 


194      REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


3  Cor^MoNt^  nn, 

DH    CoH-bULTATiOH 

He.  r^our^r^i^^oH^ 


the  tenements  with  proper  food,  and,  as  we  shall  see  later,  the  result  of  doing  this 
has  been  remarkable. 

Several  different  organizations  have  been  used  for  the  reduction  of  infant 
mortality,  and  in  France,  where,  on  account  of  the  low  birth-rate,  infant  life  is 

more  vital  to  the  prosperity  of 
the  country,  and  vigorous  means 
have  been  taken  to  lessen  infant 
mortality,  the  first  organizations 
of  this  sort  were  established. 

The  first  milk  depot  was  es- 
tablished in  Paris  by  Dr.  Variot 
in  1892,  one  year  previous  to  the 
establishment  of  the  Straus  milk 
depots  in  New  York.  Other 
institutions  for  the  accomplish- 
ment of  the  same  purpose  have 
been  organized  in  France,  where 
there  are  three  types  of  such 
institutions — the  Mutualite  Ma- 
ternelle,  intended  to  help  the 
mothers  who  are  nursing  their 
babies,  as  well  as  to  assist  in  the 
intrauterine  development  of  the 
child  and  to  assist  the  mother,  if 
necessary,  during  the  first  months 
of  the  child's  life  while  she  is 
nursing  it;  the  Consultations  de 
Nourrissons,  which  are  attached 
to  the  obstetrical  clinics  and  are 
intended  to  encourage  the  moth- 
ers to  nurse  their  children,  if 
possible,  and,  where  necessary, 
to  furnish  a  proper  substitute  for 
breast  milk;  and  the  Gouttes  de 
Lait,  which  are  simply  milk  dis- 
pensaries where,  while  nursing  is 
encouraged,  proper  advice  con- 
cerning artificial  feeding  is  given. 
The  benefit  derived  from  all 
these  institutions  has  been  so  evident  that  their  organization  has  spread  rapidly, 
and  milk  depots  may  now  be  found  in  most  of  the  countries  of  the  world — in 
France,  Spain,  Russia,  Sweden,  Italy,  Switzerland,  Germany,  England,  as  well  as 
in  South  America  and  Africa.  New  York  city  now  has  some  75  milk  depots,  55  of 
which  are  under  the  supervision  of  the  Department  of  Health. 


Fig. 


3. — In  Auxerre,  in  1898,  with  no  milk  depots,  205 
infants  under  one  year  of  age  of  every  1000  born  died; 
in  1904,  with  some  milk  depots,  140  died;  wliile  in 
1905,  with  a  considerable  increase  in  milk  depots,  only 
60  died.  The  mortality  at  the  same  time  in  infants 
fed  at  the  milk  depots  was  considerably  less — only  13 
per  1000  in  1904  and  i7  per  1000  in  1905;  while  in 
this  chart  these  results  are  compared  with  other  towns 
having  no  milk  depots,  giving  a  mortality  of  120,  157, 
and  214  per  1000. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       195 


The  first  milk  depots  were  all,  I  believe,  organized  through  private  philan- 
thropy, but  in  recent  years  municipalities  have  undertaken  their  organization. 
In  this  country  I  have  personally  felt  that  this  work  was  safer  in  the  hands  of 
private  philanthropy,  but  I  believe  that  those  now  organized  unflcr  our  New  York 
Health  Department  will,  for  the  present  at  least,  be  free  from  political  interference. 

Now  as  to  organization.  The  ideal  milk  dejjot,  to  my  mind,  is  one  equipped 
with  rooms  for  preparing  the  milk,  pasteurizing  it  in  the  nursing  bottles  and 
distributing  it  from  depots  very  near  the  home  of  the  mother  at  cost,  or  to  the 
destitute  free.  The  ideal  equipment  for 
accomphshing  this  would  be  a  large  plant 
for  preparing  and  pasteurizing  the  milk, 
with  a  consulting-room  and  dispensing- 
room  attached  and  with  refrigerator 
wagons  for  transporting  the  milk.  There 
should  also  be  a  number  of  substations 
for  distribution  and  consultation,  with 
still  more  substations  for  distribution 
only.  Each  of  the  consulting  stations 
should  be  provided  with  a  physician,  who 
would  spend  certain  hours  there  eacli 
day,  and  a  nurse,  who  would  spend  all 
her  time  on  the  work  in  the  depot  and 
the  homes. 

This  scheme  provides  the  most  eco- 
nomical method  of  preparing  and  dis- 
tributing the  milk.  It  provides  consult- 
ing rooms,  where  the  mother  may  take 
her  baby  once  a  week  for  weighing  and 
for  ad\'ice,  as  well  as  nearer  distributing 
stations,  where  the  milk  may  be  obtained 
on  other  week  days  without  going  as  far 
as  the  consulting  station. 

It  was  estimated  that  for  New  York 
an  endowment  of  $5,000,000  would  be 
necessary  to  establish  and  support  such 

plants  in  all  boroughs,  and  although  efforts  were  made  to  obtain  this  endowment, 
no  philanthropist  could  be  found  who  was  willing  to  furnish  the  capital. 

The  Straus  milk  depots  endeavored,  in  a  limited  way,  to  carry  out  these  ideas. 
They  have  used  certified  milk  which  has  been  pasteurized  in  the  nursing  bottles 
and  which  was  distributed  with  a  sterile  nipple  for  each  bottle.  They  have  not 
accomplished  all  that  they  might,  because,  in  the  first  place,  there  are  too  few  of 
them,  and  not  a  sufficient  equipment  of  doctors  and  nurses. 

Although  I  believe  the  ideal  equipment  is  what  should  be  pro\-ided,  I  am 
convinced  that  very  efficient  work  can  be  done  with  less  equipment,  where  the 


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i. — In  Sens  the  mortality  before  the  es- 
tablishment of  milk  depots,  in  1898,  was 
IIG  per  1000.  This  fell  in  1904  to  80  and 
in  1905  to  -tT;  while  the  mortality  among 
the  children  fed  at  the  milk  depots  was  ii 
in  1904  and  iG  in  1905. 


196       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

funds  are  limited,  when  certified  milk  is  distributed  and  clinics  are  held  by  phy- 
sicians, and  nurses  are  provided  who  are  active  in  the  milk  depots  and  at  the 
homes.  Thus  the  New  York  Diet  Kitchen  Association  which,  with  a  small  income 
from  subscriptions  and  endowment,  was  doing  a  very  limited  work  in  dispensing 
milk  to  babies  and  invahds,  has  recently  rapidly  expanded  its  work  through  a 
policy  of  charging  those  who  can  afford  to  pay,  so  that  during  the  past  year,  with 


S"^  T'ok.-  3\jn-  >^c.< 


Fig.  5.— In  Ville  de  Toucy,  while  before  the 
establishment  of  milk  depots  the  mortality 
of  infants  under  one  year  was  197.3,  it  fell 
in  1905  to  1'20  and  in  190G  to  50.5. 


Fig.  6.— At  St.  Pol-sur-Mer,  a  mortality  of  2S8 
before  the  establishment  of  milk  depots 
was  reduced  to  151. 


an  income  of  some  $82,000,  $45,000  of  which  was  contributed  by  the  mothers 
who  bought  the  milk,  they  have  been  able  to  dispense  more  than  a  million  quarts 
of  milk  from  nine  stations,  and  their  results  have  been  wonderfully  good.  Con- 
sultations with  physicians  are  held,  and  trained  nurses  have  been  attached  to  some 
of  the  depots  and  will  soon  be  attached  to  all.  The  mortality  in  the  cases  treated 
at  these  depots  has  been  extremely  small.  Of  2421  babies  under  their  care  between 
June  and  October  last,  four  months,  including  the  summer  months,  they  report 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       197 


only  thirty  deaths  from  all  causes,  a  mortality  of  1.2  per  cent,  for  these  hot  summer 
months.  Their  results,  I  lielievc,  could  not  be  very  materially  improved  were  the 
milk  dispensed  pasteurized  in  nursinp  bottles. 

On  the  other  hand,  I  still  believe  that  where  funds  are  available  the  scheme 
that  I  first  mention  should  be  carried  out. 

As  to  the  results  of  milk  depots  in  lowering  mortality,  it  has  been  found  that 
where  they  are  generally  estab- 
lished so  as  to  sujjply  all  the  Viuceuv^ - s>.n-'(.""W-Hiw~t.t d> t. 
babies  that  need  their  help  a  re- 
duction of  about  60  per  cent,  is 
obtained.  This  has  been  repeat- 
edly demonstrated  in  France,  and 
the  accompanying  charts  show 
similar  results  from  different  sorts 
of  milk  charities  both  in  France 
and  in  this  country. 

Excellent  illustrations  of  the 
efficiency  of  infant  milk  depots 
on  mortality  are  the  results  of 
the  establishment  of  milk  depots 
in  the  villages  in  the  Province 
of  Bouches-du-Rhonc  in  southern 
France,  as  shown  graphically  in 
charts  by  P.  Budin.* 

The  general  movement  for 
the  establishment  of  milk  depots 
in  this  province  was  begun  in 
1903.  In  order  to  ascertain  the 
efficiency  of  this  establishment  of 
milk  depots,  the  mortality  in  the 
towns  having  milk  depots  in  1904 
was  compared  with  that  of  the 
same  towns  in  the  year  1898, 
and,  as  seen  in  Fig.  1,  the  mor- 
taUty  in  all  the  eleven  towns 
containing  milk  depots  showed 
some  diminution.  In  order  to 
be  sure  that  this  was  not  due  to 
other  conditions  than  the  milk 

depots,  the  mortality  in  the  same  years  of  these  eleven  towns  was  compared  with 
eleven  neighboring  towns  in  which  no  milk  depots  were  established  (Fig.  'i)  and  it 
was  found  that  in  the  last  eleven  towns  there  was  an  invariable  increase  in  mor- 
tality in  1904  over  1898. 

*"La  Mortalite  Infantile  dans  les  Bouches-du-Rhone,"  by  Pierre  Budin.  L'Obstetricjue,  July, 
1907. 


.  7. — In  Villeneuve-sur-Yonne.  a  morUlity  of  103  was 
reduced  to  only  3-2,  while  the  mortality  there  in  milk- 
depot-fed  children  was  G6  in  190-1  and  0  in  1903. 
These  figures  are  compared  on  this  chart  with  those 
of  three  other  towns  of  the  same  district  having  no  milk 
depots,  which  show  a  motality  in  1905  of  17G,  163 
and  117. 


198       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

These  figures  encouraged  the  expansion  of  this  work,  so  that  in  1905  a  very 
much  larger  number  of  infants  were  fed,  and  with  this  a  greatly  diminished  death- 
rate  was  noted. 

Thus,  in  Fig.  3,  it  will  be  seen  that  in  Auxerre  in  1898,  with  no  milk  depots, 
205  infants  under  one  year  of  age  of  every  1000  born  died;  in  1904,  with  some 
milk  depots,  120  died;  while  in  1905,  with  a  considerable  increase  in  milk  depots, 
only  60  died.     The  mortality  at  the  same  time  in  infants  fed  at  the  milk  depots 


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Fig.  8.— Comparison  of  the  death  rate  in  Yonkers  before  and  after  the  establishment  of  milk  depots 
with  that  of  other  neighboring  cities  of  similar  size  without  milk  depots. 


was  considerably  les.s— only  13  per  1000  in  1904  and  27  per  1000  in  1905;  while 
in  this  same  chart  these  results  are  compared  with  other  towns  having  no  milk 
depots,  giving  a  mortality  of  120,  157,  and  214  per  1000. 

Again,  at  Sens  (Fig.  4)  the  mortality  before  the  establishment  of  milk 
depots  in  1898  was  116  per  1000.  This  fell  in  1904  to  80,  and  in  1905  to  47;  while 
the  mortaUty  among  the  children  fed  at  the  milk  depots  was  14  per  1000  in  1904 
and  26  in  1908. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE 


199 


MoI\TA.uiT1    m 
New  lORl^  City 


Again,  in  Ville  de  Toucy  (Fig.  5),  while  before  the  estahhshment  of  milk 
depots  the  mortality  of  infants  under  one  year  was  197.3  per  1000,  it  fell  in  1905 
to  120,  and  in  1906  to  50.5. 

At  St.  Pol-sur-Mer  (Fig.  6)  a  mortality  of  288  before  the  establishment 
of  milk  depots  was  reduced  to  151;  while  in  Villencuvc- 
sur-Yonne  (Fig.  7)  a  mortality  of  1C3  per  1000  was  re- 
duced to  only  32,  while  the  mortality  there  in  milk-depot- 
fed  children  was  66  in  1904  and  none  in  1905.  These 
figures  are  compared  on  the  same  chart  with  those  of  three 
other  towns  of  the  same  district  having  no  milk  depots, 
which  show  a  mortality  in  1905  of  176,  163,  and  117. 

If  we  take  the  average  of  the  reduction  in  mortality 
in  Auxerre,  Sens,  \ille  de  Toucy,  St.  Pol-sur-Mer  and 
Villeneuve-sur-Yonne,  we  find  that  the  infant  mortality 
in  these  towns  after  the  establishment  of  milk  depots  was 
about  38  per  cent,  of  what  it  was  before,  showing  a  62 
per  cent,  reduction  in  mortality. 

In  this  country  marked  reduction  in  infant  mortality 
following  the  establishment  of  infant  milk  depots  has  been 
noted  by  Getty*  in  Yonkers  (Fig.  8),  where  milk  depots 
were  established  in  1895.  P^or  three  years  previous  to  the 
establishment  of  milk  depots  the  deaths  of  children  under 
five  years  of  age  averaged  162  per  1,000.  In  1896  they 
were  reduced  to  135,  while  the  deaths  for  the  three  years 
previous  to  the  establishment  of  these  depots  from  diar- 
rhea had  been  91,  they  were  reduced  in  1896  to  48.  Dur- 
ing the  same  period  the  mortality  in  three  neighboring 
towns  of  similar  population  showed  usually  an  increase  in 
1896  over  the  period  of  1892-95  for  the  class  under  five 
years  of  age,  and  also  from  diarrhea. 

In  New  Y'ork  a  diminution  of  mortality  following  the 
establishment  of  milk  depots  also  occurred,  although  there 
were  other  factors  that  were  active  at  that  time,  and  this 
reduction  cannot  be  attributed  entirely  to  milk  depots. 
The  mortality  of  infants  under  one  year,  before  the  estab- 
lishment of  milk  depots  in  1891  (Fig.  9),  was  244,  while  in 
1902  it  was  reduced  to  158,  and  in  1906  to  144.  They 
reached,  however,  only  3,500  out  of  a  population  of 
205,000  infants  under  two  years. 

The  best  illustration  of   the  benefit  of   milk  depots 
in  New  York  City  is  the  result  of  observations  carried  on  by  the  Rockefeller  Insti- 
tute under  the  supervision  of  Drs.  Park  and  Holt,t  on  the  condition  of  children  fed 

*  New  York  Medical  Journal,  No.  15,  18,  pp.  484-489. 
t  Archives  of  Pediatrics,  No.  li,  1903,  pp.  881-909. 


Fig. 


9. — In  New  York  a 
diminution  of  mortal- 
ity following  the  estab- 
lishment of  milk  depots 
also  occurred.  The 
mortality  of  infanta 
under  one  year,  before 
the  estal^lishment  of 
milk  depots  in  1891, 
was  244,  while  in  1902 
it  was  reduced  to  158 
and  in  1906  to  144. 


200 


REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 


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Fig.  10. — The  best  illustration  of  the 
benefit  of  milk  depots  in  New  York 
city  was  the  result  of  observations 
carried  on  by  the  Rockefeller  Insti- 
tute under  the  supervision  of  Drs. 
Park  and  Holt  on  the  condition  of 
children  fed  in  the  tenements  on  dif- 
ferent sorts  of  food.  The  mortality 
of  70  children  ted  on  condensed  milk 
during  the  summer  was  20  per  cent.; 
while  of  those  fed  on  store  milk  it 
was  19  per  cent.;  on  good  bottled 
milk,  9  per  cent.;  while  the  infants 
fed  from  milk  depots  showed  a  mor- 
tality of  only  i.l  per  cent. 


in  the  tenements  on  different  sorts  of  food,  as 
seen  in  Fig.  10.  The  mortahty  of  seventy- 
children  fed  on  condensed  milk  during  the 
sunnner  was  20  per  cent.;  while  of  those  fed 
on  store  milk  it  was  19  per  cent.;  on  good 
bottled  milk,  9  per  cent.;  while  the  infants  fed 
from  milk  depots  showed  a  mortality  of  only 
2.7  per  cent. 

It  is  evident  from  the  results  indicated  in 
the  foregoing  figures  that  if  milk  depots  could 
be  established  in  New  York  with  a  sufficient 
number  of  distributing  points,  so  that  each 
tenement-house  mother  could  readily  obtain 
proper  milk  for  her  baby,  a  reduction  in  infant 
mortality  .similar  to  that  shown  in  certain 
towns  in  France  should  be  accomplished;  that 
is,  a  reduction  of  about  60  per  cent.,  so  that 
the  17,000  deaths  under  one  year  should  be  re- 
duced by  10,500,  or  to  6500,  while  a  consider- 
able saving  in  the  lives  of  children  between  one 
and  two  years  of  age  would  also  result,  and 
that  while  every  small  movement  of  this  sort 
will  have  an  impression,  no  very  evident  fife- 
saving  can  be  brought  about,  or  useful  lesson 
for  other  communities  taught,  unless  such 
depots  are  established  on  a  large  scale. 

It  is  interesting  to  ascertain,  if  possible, 
whether  this  decrease  of  60  per  cent,  is  owing 
to  the  dispensing  of  a  clean,  healthful  milk  or 
to  the  education  of  the  mothers,  which  is  a 
part  of  the  function  of  milk  depots.  We,  for- 
tunately, have  had  in  New  York  an  oppor- 
tunity of  ascertaining  fairly  accurately  what 
can  be  done  by  education  alone,  for  the  Asso- 
ciation for  Improving  the  Condition  of  the 
Poor  in  our  city  has  always  held  that  the  poor 
shoidd  be  helped  by  teaching  them  to  help 
themselves  and  not  by  establishing  plants  to 
help  them,  and  their  attitude  was  probably  one 
reason  why  it  was  impossible  to  obtain  a  large 
bequest  for  the  establishment  of  milk  depots. 

To  show  the  effect  of  education  alone,  this 
Society  equipped  one  Assembly  District  in 
New  York  with  ample  doctors  and  nurses,  who 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       201 

visited  the  homes,  established  cHnics  at  a  central  depot,  and  instructed  the  mothers 
in  the  essentials  for  the  preservation  of  health  in  their  children  and  the  details  of 
the  preparation  of  the  milk,  allowing  them,  however,  to  purchase  the  milk  at  the 
grocery.  To  what  extent  they  directed  the  mothers  to  good  milk  supplies  I  do 
not  know,  but  from  their  results  I  imagine  that  not  much  was  done  in  that  w\iy. 
An  indication  of  the  amount  of  work  they  did  can  be  shown  by  the  fact  that  they 
visited  more  than  116,000  families,  where  they  gave  instruction  in  feeding,  cook- 
ing, clothing,  fresh  air,  nursing  and  general  care. 

The  mortality  in  this  Assembly  District,  as  compared  with  the  rest  of  the 
city,  showed  that  while  the  total  deaths  from  all  causes  in  the  entire  city  increased 
4  per  cent.,  in  this  Assembly  District  they  diminished  11  per  cent.;  while  the 
deaths  from  diarrhea  in  the  whole  city  increased  1  i)er  cent.,  in  this  .Vssembly  Dis- 
trict they  diminished  10  per  cent.;  and  the  total  deaths  from  diarrhea  under  five 
years,  which  in  the  whole  city  increased  3  per  cent.,  in  this  Assembly  District 
diminished  I'i  per  cent.;  so  that  we  get  a  diminution  in  mortality  in  this  Assembly 
District  of  about  15  per  cent.  Wc  may,  therefore,  conclude  that  the  educational 
features  of  milk  dejiots  will  not  give  us  much  more  than  a  15  per  cent,  reduc- 
tion in  infant  mortality,  but  we  have  already  seen  that  milk  depots  with  edu- 
cation produce  a  60  per  cent,  reduction  in  mortality,  so  we  are  left  to  credit  good 
milk  with  about  45  per  cent. 

These  figures,  while  not  accurate,  seem  to  me  significant,  and  I  believe  the 
claim  of  philanthropists,  that  education,  not  milk,  is  necessary,  is  false.  The 
poor  need  education,  but  they  need  clean,  healthful  milk  much  more. 

Mk.  Folks:  The  discussion  of  Dr.  Freeman's  paper  will  be  opened  by  Dr. 
William  C.  Woodward,  Health  Officer  of  the  District  of  Columbia. 

DISCUSSION  ON  DR.  RO\M>.\ND  G.  FREEMAN'S  PAPER 

Dr.  \Yillia.m  C.  Woodward:  I  am  sure  we  have  listened  with  a  great  deal  of  interest  to  what 
has  been  said  about  the  work  of  milk  stations.  Certainly  no  one  will  deny  the  importance  of  milk 
stations,  nor  the  wonderful  good  that  they  accomplish  through  the  food  which  they  distribute.  As 
has  been  pointed  out,  however,  there  are  two  factors  to  be  considered  in  the  work  of  milk  stations,  one 
being  the  food,  and  the  otlier,  the  instruction.  I  would  not  be  understood  as  belittling  the  importance 
of  the  food  when  I  say  that  the  instruction  is  both  for  present  purposes  and  for  the  future,  in  my  judg- 
ment, the  more  important.  The  supplying  of  a  good  milk  through  the  medium  of  milk  stations  is  im- 
portant for  two  main  reasons;  the  first  is  that  it  insures  the  baby  a  clean  safe  food,  and  the  second,  that 
it  gives  an  educational  agency  access  to  the  home. 

I  can  hardly  understand  how  the  supplying  of  good  milk  alone  could  by  any  possibility  have  ef- 
fected a  reduction  of  CO  per  cent,  or  even  of  -15  per  cent,  in  the  mortality  among  children  less  than  one 
year  of  age.  I  say  that  because,  so  far  as  I  know,  although  I  must  confess  that  I  have  not  looked  into 
the  figures  recently,  the  mortality  from  diarrheal  diseases  among  children  of  one  year  of  age  and  under 
has  nowhere  been  reduced  by  anything  like  00  per  cent,  or  even  -13  per  cent.  Possibly  25  per  cent,  to 
30  per  cent,  would  fairly  represent  the  percentage  reduction  in  the  mortality  from  these  diseases.  If 
the  distribution  of  milk  had  totally  arrested  diarrheal  diseases,  we  could  not  even  then  look  for  a  re- 
duction of  anything  like  45  per  cent.,  while,  as  a  matter  of  fact,  we  know  that  the  milk  depots  reach 
only  a  small  proportion  of  the  children  in  any  community. 

It  may  be  said  that  milk  depots  exert  an  influence  on  the  prevention  of  disease  and  death  resulting 


202       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

from  other  causes  than  diarrheal  diseases,  and  that,  of  course,  may  be  true;  and  yet  I  think  we  must 
admit  that  that  is  a  rather  remote  influence,  so  far  as  the  food  itself  is  concerned.  We  can  hardly  say 
that  these  depots,  tlirough  their  milk,  prevent  pneumonia,  bronchitis,  diphtheria,  scarlet  fever,  or  other 
contagious  diseases  in  the  first  year  of  life.  For  that  reason  I  think  we  must  attribute  the  improvement 
not  so  much  to  the  milk  as  to  the  influence  of  the  nurse  who  must  accompany  the  milk. 

There  is  another  factor  that  possibly  is  not  generally  understood,  with  respect  to  this  infant  mor- 
tality in  the  first  year  of  life,  and  that  is  a  factor  which  the  milk  station  can  influence  but  little.  I 
refer  to  the  mortality  on  the  first  day  of  life.  Certainly  we  camiot  attribute  to  a  milk  station  any  in- 
fluence over  that  mortality;  and  yet,  speaking  for  my  own  city  of  Washington,  we  found,  for  instance, 
in  1911,  that  out  of  957  deaths  that  occurred  in  the  first  j'ear  of  life,  151  occurred  on  the  first  day,  130 
occurred  between  one  day  and  one  week,  and  114  between  one  week  and  one  month.  In  other  words, 
41  per  cent,  of  the  mortality  in  the  first  year  of  life  occurred  in  the  first  month,  and  about  one-sixth 
occurred  on  the  first  day.  These,  of  course,  are  not  exceptional  figures,  because  in  the  previous  year, 
out  of  1070  deaths,  150  occurred  on  the  first  day,  and  in  the  year  preceding  that,  out  of  1042  deaths,  140 
occurred  on  the  first  day.  So  we  must  look  somewhere  beyond  the  milk  for  the  prevention  of  infant 
mortality.  W'e  must  look  to  the  education  of  the  mother,  and  the  education  of  the  older  sister,  and 
the  providing  for  needs  other  than  the  mere  need  of  proper  food. 

We  must  begin  the  education  of  the  mother  before  the  child  arrives,  so  that  we  may  arrest  at  least 
some  part  of  this  mortality  of  the  first  day  of  life,  and  we  must  follow  the  child  through  the  first  day  and 
onward  more  closely  than  we  have  done  or  are  doing  now. 

One  thing  with  respect  to  midwives.  It  may  be  a  little  out  of  relation  to  the  discussion  of  milk 
stations,  and  yet  from  my  point  of  view,  attaching  as  I  do  so  much  importance  to  the  educational  work, 
it  is  interesting  to  find  that  while  we  have  diminished  the  percentage  of  births  attended  by  midwives 
from  about  50  per  cent,  of  the  total  number  to  15  per  cent.,  nevertheless  this  terrible  mortality  in  the 
first  day  of  life  and  in  the  first  week  and  first  month  has  not  diminished,  but  has  actually  risen.  The 
number  of  babies  that  die  on  the  first  day  of  life  is  greater  now  than  it  was  five  years  ago,  whether  you 
compute  it  on  the  basis  of  the  total  population,  or  whether  you  compute  it  on  the  basis  of  the  births 
registered. 

And  so  we  come  to  the  second  factor  of  the  work  of  the  milk  station,  and  that  is  the  educational 
work.  I  have  said  that  the  milk  station  is  valuable,  both  because  it  provides  for  the  needs  of  the  baby 
by  giving  it  the  milk  it  must  have,  and,  what  is  more  important  in  the  long  run,  because  it  provides 
for  the  education  of  the  mother  and  of  the  older  sisters  and  brothers;  so  that  as  time  goes  on  we  will 
have  more  intelligent  preparation  for  motherhood,  and  we  shall  have  a  better  provision  for  the  infant 
when  it  arrives.  I  agree  most  thoroughly  in  everything  that  has  been  said  respecting  the  importance 
of  a  proper  diet;  but  I  think,  after  all,  that  there  is  a  probably  greater  amount  of  good  resulting  from 
the  education  that  goes  with  the  diet. 

Mr.  Folks  :  The  question  of  milk  stations  is  now  open  for  general  discussion 
for  about  fifteen  minutes,  and  no  speaker  may  occupy  more  than  five  minutes. 

Dr.  S.  Josephine  Baker:  I  agree  with  Dr.  Woodward  most  thoroughly  as  to  the  educational 
value  of  the  milk  station,  and  I  hope  this  side  of  the  work  will  receive  still  greater  emphasis  in  the  future 
than  it  has  hitherto.  In  fact,  the  only  reason  for  furnishing  milk  at  milk  stations  at  the  present  time 
is,  so  far  as  I  know,  because  no  municipality  is  able  to  supply  its  citizens  with  a  steady  supply  of  good 
milk  for  infant  feeding,  and  if  I  am  not  mistaken.  Dr.  Freeman  advocates  having  suflicient  depots  around 
the  city,  or  having  the  milk  stores  so  carefully  regulated  that  the  people  may  get  pure  milk  at  all  times. 
I  should  like  to  see  the  time  arrive  when  a  mother  may  obtain  proper  milk  in  any  part  of  the  city,  and 
then  the  milk  station  may  be  used  wholly  for  educational  purposes. 

The  point  brought  out  by  Dr.  Woodward  with  regard  to  the  question  of  deaths  of  babies  in  the 
first  days  of  life  is  exceedingly  interesting.  Practically  the  entire  reduction  in  infant  mortality  in  New 
York  City  has  taken  place  in  dia  rrheal  diseases.  Practically  no  reduction  is  noted  in  the  large  number  of 
cases  of  congenital  disease,  so  called,  from  wliich  the  deaths  occurred  during  the  first  few  weeks  of  life. 


PROCEEDINGS  OF  COXFEREXCE  OX  IXFAXT  UYGIEXE       203 

They  furnish  about  35  per  cent,  of  the  total  number  of  deaths,  and  they  are  just  as  high  now  as  they 
were  twenty  years  ago. 

There  is  no  question  whatsoever  that  if  we  are  to  reduce  our  infant  mortality  very  much  further, 
we  have  got  to  concentrate  our  attention  upon  the  so-called  congenital  cases,  and,  consequently,  the  milk 
station  must  be  more  and  more  an  educational  center  for  the  prenatal  care  of  the  mother.  \Ve  are  try- 
ing to  develop  that  work,  and  it  is  exceedingly  difficult,  but  I  think  we  shall  be  able  to  carry  it  out  to 
some  degree. 

We  are  also  educating  the  girls  in  the  public  schools.  \Ve  have  had  our  "little  mothers'  "  meet- 
ings, and  last  year  20,000  school  girls  were  taught  the  proper  way  to  take  care  of  babies. 

Another  point  I  want  to  bring  out  is  that  I  have  the  greatest  admiration  for  the  work  of  the  New 
York  Diet  Kitchen  Association.  I  have  been  associated  with  that  for  the  last  two  years.  We  must 
not,  however,  rely  too  much  on  the  city  for  funds  for  work  of  this  nature.  For  two  years  the  Depart- 
ment of  Health  has  furnished  to  these  eight  stations  the  dix^tors  and  the  nurses,  and,  of  course,  their 
salaries  have  been  paid  entirely  by  the  city,  so  that  the  educational  side  of  the  work  at  the  eight  stations 
has  been  paid  out  of  the  city  funds.  The  results  are  admirable,  but  it  is  not  (juitc  the  proper  proportion 
of  expenditure  to  credit  them  all  to  the  private  agency. 

The  medical  attendance  and  inspection  of  the  infant  arc  looked  upon  as  so  integral  a  part  of  the 
work  of  our  milk  stations  that  in  one  instance  last  summer,  when  a  mother  persistently  refused  to  bring 
her  child  to  the  milk  station,  where  it.s  progress  could  be  watched,  and  where  she  could  be  taught  as  to 
its  proper  care,  she  was  no  longer  allowed  to  receive  milk  for  herself  and  for  the  baby. 

Dr.  W.  S.  Cornell:  It  seems  to  me  that  considerable  money  and  effort  could  be  saved  in  the 
distribution  of  milk  if  that  work  could  be  taken  over  by  drug-stores,  all  of  which  possess  facilities  for 
caring  for  milk.  The  proper  sort  of  milk  would  then  be  available  in  every  neighborhood  in  the  city. 
In  a  very  short  time  the  druggist  would  learn  to  kni)W  the  amount  of  milk  necessary  to  carry  to  meet 
the  daily  demand  of  his  particular  locality,  which  would  in.sure  against  waste. 

I  believe  that  the  modification  of  milk  is  sometimes,  I  wont  say  overdone,  but  perhaps  given 
relatively  too  much  attention,  compared  with  some  of  the  other  important  factors.  If  we  used  three 
standard  modifications,  for  instance,  and  devoted  more  time  to  the  other  factors  involved  in  the  problem, 
we  couM  probably  get  better  results  in  the  long  run  than  we  do  now.  I  believe  that  we  could  have  this 
milk  certified  by  the  proper  authority,  the  Bureau  of  Health,  for  instance,  tested  by  its  experts,  and  then 
placed  in  these  drug  stores,  where  it  would  be  available  for  the  private  physicians  of  the  neighborhood. 
We  talk  much  of  the  physicians  in  connection  with  this  work,  having  in  mind  the  dispensary  physician, 
who  is  usually  a  young  man,  connected  with  the  teaching  staff  of  some  one  of  the  medical  colleges,  and 
through  this  connection,  more  or  less  trained  in  pediatrics.  But  we  should  not  forget  that  two-thirds 
of  the  children  never  see  such  a  doctor.  They  are  treated  by  physicians  untrained  in  pediatrics,  and 
often  not  even  American  born,  men  who  are  out  of  touch  with  the  whole  situation.  These  men  feel  that 
they  are  likely  to  lose  their  patients  if  they  refer  them  to  the  milk  stations,  and  consequently  they  do 
not;  and  we  can  scarcely  blame  them  for  adopting  measures  which  are  likely  to  lose  them  their  means 
of  livelihood.  If  we  place  good  milk  within  reach  of  their  patients,  I  believe  they  will  take  advantage  of 
the  opportunity  to  use  it.     I  think  we  should  at  least  cooperate  with  them  to  this  extent. 

I  think  also  that  the  druggists  would  be  very  glad  to  handle  the  milk,  because  such  procedure 
would  be  more  or  less  of  an  advertisement  for  them. 

Miss  Perkins:  I  have  been  able  to  observe  the  work  of  the  milk  stations  in  Philadelphia  for 
the  last  two  years,  and  have  come  to  the  conclusion  that  the  distribution  of  milk  alone  does  not  solve 
this  feeding  problem.  What  the  mothers  obtain  from  the  milk  station  is  an  article  already  prepared  for 
them;  if  for  any  reason  the  time  comes,  and  it  does  come  very  frequently,  when  these  mothers  have  to 
move  out  of  the  range  of  a  milk  station,  they  are  at  once  deprived  of  its  advantages,  and  utterly  unfitted 
to  secure  or  supply  a  substitute.  Therefore,  I  feel  that  the  best  way  in  which  to  help  these  mothers 
is  to  teach  them  how  to  modify  the  milk  in  their  homes,  and  to  impress  upon  them  the  necessity  of  always 
securing  a  good  milk,  advice  concerning  wliich  point  can  always  be  obtained  from  the  Department  of 
Health.  This  not  only  equips  the  mother  against  all  emergencies,  but,  as  has  been  said,  opens  the  home 
for  a  more  satisfactory  carrying  out  of  our  follow-up  work.  Neglect  of  this  provision  is  one  of  the  under- 
lying reasons  for  the  extensive  use  of  condensed  milk  and  other  equally  objectionable  proprietary  foods. 
15 


204       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Mr.  Folks:  K  the  chair  may  talk  for  just  a  second,  I  would  like  to  point  out  that  the  milk  station 
is  only  one  of  our  agencies.  After  all,  it  is  a  development  from  the  medical  and  nursing  station,  and  is 
only  one  of  four  or  five  directions  in  which  we  are  rapidly  advancing,  for  the  benefit  of  the  whole  com- 
munity, our  medical  and  nursing  service.  In  the  course  of  the  last  year  I  have  become  very  radical  in 
one  thing,  although  very  conservative  in  most  things.  It  has  become  perfectly  clear  in  my  mind  that  in 
the  very  near  future  the  medical  and  nursing  professions  will  be  just  as  much  servants  of  the  public 
and  organized  for  the  benefit  of  the  entire  community  as  is  the  teaching  profession  today.  We  are 
headed  directly  and  rapidly  in  that  direction,  and,  in  my  judgment,  the  faster  we  go  the  better. 

Dr.  Freeman:  I  would  like  to  ask  Dr.  Woodward  if  his  conclusions  were  based  on  reliable  statis- 
tics, for  otherwise  I  think  they  must  have  been  largely  hypothetic.  We  do  not  claim  that  a  reduction 
of  60  per  cent,  in  the  mortality  was  effected  solely  by  the  supplying  of  pure  milk,  and  it  was  not  so  stated 
in  my  paper.  I  do  not  belittle  at  all  the  educational  value  of  the  milk  station,  but  I  tried  to  emphasize 
the  other  side  of  the  problem — the  value  of  good  milk — because  I  think  the  social  workers  ought  to  know 
and  appreciate  its  value. 

Mr.  Folks:  When  we  handle  percentages  we  are  very  likely  to  get  into  trouble  unless  we  state 
whether  it  is  a  percentage  of  total  mortality,  or  whether  it  relates  to  a  particular  case  or  district. 

Dr.  Woodward:  I  did  not  mean  to  say  that  a  reduction  of  60  per  cent,  did  not  occur,  but  that 
a  reduction  of  60  per  cent,  had  not  occurred  simply  because  of  the  distribution  of  food.  I  would  esti- 
mate that  a  certain  part  of  that  60  per  cent,  was  due  to  the  education  that  goes  along  with  the  milk 
distribution. 

Mr.  Folks:  We  ■nill  jiroceed  to  the  next  topic,  which  i.s  "Social  Service 
Work  in  Relation  to  The  Conservation  of  Child  Life."  I  have  pleasure  in  present- 
ing to  you  Dr.  Fritz  Talbot,  of  the  Pediatric  Department  of  the  Harvard  Medical 
School. 


A  CONSIDERATION  OF  THE  SOCIAL  SERVICE  WORK  OF 

THE  DEPARTMENT  OF  DISEASES  OF  CHILDREN  IN 

THE  MASSACHUSETTS  GENERAL  HOSPITAL 

BY  DR.  FRITZ  B.  T.\LBOT 


The  seed  of  hospital  social  service  work  was  planted  seven  years  ago*  by  Dr. 
Richard  Cabot,  in  The  Massachusetts  General  Hospital.  The  work  has  developed 
and  spread  so  rapidly  that  now  there  is  hardly  a  physician  in  the  out-patient 
departments  who  is  not  consulting  with  and  using  the  social  workers.  The  work 
in  the  past  has  not  been  entirely  satisfactory  because  the  results  have  not  been 
commensurate  ■nith  the  energy  expended.  This  is  particularly  true  of  the  adult; 
the  tendency,  therefore,  has  been  to  devote  more  and  more  time  to  children,  who 
can  be  educated.  Education  and  preventive  medicine  are  bringing  results  of  greater 
importance  than  those  obtained  in  curative  medicine,  and  the  healthy  child 
makes  a  good  foundation  on  which  to  build  the  healthy  adult.  The  social  workers 
are,  therefore,  concentrating  their  energies  more  and  more  on  work  among  babies 
and  children.     In  this  way  a  few  himdred  dollars  used  in  preventing  disease  gives 

*  Since  presenting  this  paper  the  writer  has  learned  that  Dr.  Chapin,  of  New  York,  has  had  a 
Social  Service  department  in  his  hospital  for  ten  years. 


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205 


206       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

a  dividend  of  thousands  of  dollars  representing  chronic  diseases  of  later  life  which 
have  been  stopped  at  the  onset  or  prevented.  It  is  only  necessary  to  walk  around 
the  wards  of  anj'  large  general  hospital  to  see  the  wrecks  of  humanity  who  might 
have  been  strong,  healthy  persons  had  they  come  under  the  proper  influences  in 
their  youth. 

It  is  a  common  experience  in  all  medical  out-patient  clinics  to  find  that  careful 
work  on  the  part  of  the  physician  means  an  increase  in  the  number  of  his  patients. 
The  public  appreciates  such  effort.  As  a  result,  the  physician  is  not  able  to  keep 
pace  with  the  demands  put  upon  him.  For  example,  the  Children's  Medical 
Department  of  the  Massachusetts  General  Hospital  had  an  average  of  eight 
patients  a  day  two  .years  ago;  last  month  it  had  an  average  of  22  cases  a  day,  and 
additional  social  service  workers  have,  therefore,  been  necessary.  This  large  in- 
crease in  attendance  necessitated  the  appointment  of  the  three  assistants  shown 
on  the  chart.  The  best  work  in  any  clinic  depends  upon  two  factors,  skilled  advice 
on  the  part  of  the  j^hysician  and  confidence  on  the  part  of  the  patient.  Neither 
of  these  alone  results  in  successful  treatment.  It  is  here  that  the  social  worker 
is  of  the  utmost  value;  the  most  important  part  in  the  whole  scheme  is  that  the 
social  worker  shall  be  a  member  of  and  work  in  the  clinic.  Dr.  Abner  Post,  of  the 
Boston  Dispensary,  says  that  he  "wants  these  social  workers  to  be  so  much  a  part 
of  the  clinic  that  the  patient  will  not  know  where  the  social  work  begins  and  the 
medical  ends."  Our  Children's  Medical  Department  has  been  able  to  accomplish 
this.  We  started  with  a  single  social  worker  who  visited  certain  types  of  cases 
in  the  home,  supervised  the  treatment,  and  thus  made  it  possible  to  treat  many 
children  in  the  home  and  out-patient  department  who  otherwise  would  have  been 
treated  in  the  hospital  ward.  She  is  able  to  supply  the  connecting  link  between 
the  home  and  the  clinic,  i.  e.,  the  personal  element  which  is  typified  in  the  family 
practitioner. 

The  accompanying  chart  shows  graphically  what  we  are  doing  (small  type) 
and  what  we  hope  to  do  (large  type).  When  a  patient  comes  to  the  hospital,  he 
is  sent  to  a  special  department.  For  instance,  should  he  have  rachitis  he  is  sent 
to  the  orthopedic  department,  if  adenoids  and  enlarged  tonsils,  to  the  throat 
department,  and  so  on.  The  orthopedic  department  sends  the  child  with  rachitis 
to  the  Children's  Medical  Department  to  have  its  diet  and  hygiene  regulated, 
and  in  like  manner  the  throat  department  sends  its  patients  to  us  for  physical 
examination.  The  clinic  nurse,  who  takes  the  temperatures,  weighs  the  children, 
and  does  other  work  in  the  morning,  is  the  same  nurse  that  visits  the  children  at 
their  homes  in  the  afternoon;  she  is  both  a  trained  nurse  and  a  social  worker. 
Other  social  workers  are  working  under  her  direction.  At  present  one  is  investigating 
rickets,  another  heart  disease,  and  a  third,  who  is  partly  social  worker  and  partlj'^ 
a  trained  nurse,  is  to  help  in  our  preventive  work  among  the  babies  during  the 
summer. 

We  also  cooperate  with  other  agencies,  when  possible,  in  order  to  increase 
the  efficiency  of  our  work.  We  consult  and  use  the  school  nurses,  school  physicians, 
school  teachers,  visiting  nurses,  the  Anti-Tuberculosis  Societies,  the  Society  for 


PROCEEDINGS  OF  COXFEREXCE  OX  IXFAXT  HYGIEXE       207 

the  Prevention  of  Cruelty  to  Children,  the  convalescent  homes,  the  associated 
charities,  the  De[)artment  of  State  for  Minor  Wards,  the  relief  societies,  the  milk 
stations,  diet  kitchens,  vacation  homes,  hospitals,  children's  agencies,  and  so  on; 
in  fact,  we  cooperate  with  anybody  who  is  interested  in  the  work  we  are  doing. 

The  following  cases  are  examples  of  the  old  way  of  treating  patients  and  of 
the  new  way  when  the  social  worker  helps  us: 

Walter  J.,  an  Irish  boy,  twelve  years  of  age,  lives  in  the  North  Knd  of  Boston 
in  a  very  "unsanitary  tenement."  Both  of  his  parents  have  a  police  record  for 
drunkenness.  He  came  to  the  Out-Patient  Department  and  was  found  to  have  a 
"probable  tuberculosis."  Careful  directions  were  given  to  his  parents  about 
diet,  fresh  air,  rest,  and  the  regulation  of  his  habits.  He  returned  to  the  Out- 
Patient  Department  six  times  in  the  course  of  four  months,  but  continued  to  lo.se 
weiglit  and  look  more  seriously  ill.  The  treatment  of  this  rase  was,  therefore, 
unsuccessful.  The  family  situation  was  lieing  handled  by  the  Juvenile  Court 
and  the  A.ssociated  Charities.  -Miss  Beaton,  our  Social  Service  Worker,  in  co- 
operation with  both  of  these,  then  went  to  his  home  to  show  the  parents  how  to  do 
what  had  ])reviously  been  ordered.  A  back  porch  and  i)arlor  were  turned  into 
resting  and  sleeping  rooms.  The  boy  was  put  to  bed  out-of-doors,  and  for  the 
first  time  received  correct  treatment.  The  result  was  rcTUarkablc:  he  improved 
rapidly  in  health  and  gained  seven  pounds  in  three  months. 

This  case  is  a  sample  of  14  other  cases  with  some  form  of  tuI)crculosis  which 
have  been  helped  by  the  home  visits  of  the  social  worker. 

Another  important  group  of  cases  shown  on  the  chart  is  heart  disease  and 
its  complications,  in  which  are  included  chorea,  or  St.  Vitus'  dance,  and  that  very 
insidious  disease,  endocarditis.  The  following  case  is  an  example  of  what  may 
happen  to  a  child  when  proper  care  is  not  instituted: 

Samuel  R.,  six  years,  entered  the  hospital  eighteen  months  ago  with  "acute 
rheumatic  fever,"  which  was  apparently  cured  quickly  by  rest  and  drugs,  but  it 
was  discovered  before  he  went  home  that  a  slight  leak  had  developed  at  one  of  the 
valves  of  his  heart.  Five  months  later  he  was  brought  back  one  night  to  the 
accident  room,  in  a  very  serious  condition,  with  blue  lips,  coughing,  and  panting 
for  breath.  The  small  leak  had  in  the  interval  become  a  big  leak,  and  he  was 
doomed  to  the  life  of  a  cardiac  cripple.  He  remained  in  the  hospital  four  weeks 
this  time,  and  went  home  "much  relieved."  Things  went  from  bad  to  worse; 
last  month  he  entered  the  hosjjital  for  the  fourth  time,  to  die  of  heart  trouble. 

There  is  hardly  any  hospital  in  the  country  that  can  keep  a  child  long  enough 
to  cure  acute  endocarditis.  We  have  attempted  to  remedy  this  in  the  following 
way.  When  the  patient  is  acutely  sick,  he  is  sent  into  the  hospital  wards;  as  soon 
as  he  is  well  enough  to  go  home  he  is  sent  there  to  bed,  and  visited  by  the  social 
worker,  who  supervises  the  case  from  then  on.  She  visits  the  home  and  tells 
what  to  do;  she  takes  the  boy's  temperature,  and  she  tries  to  get  the  other  members 
of  the  family  interested  enough  to  help  the  child  get  well.  The  greatest  trouble 
we  have  had  is  in  keeping  the  children  interested  enough  to  stay  in  bed.  In  two 
instances  we  were  fortunate  to  have  a  student  volunteer  who  was  willing  to  visit 
the  children  three  times  each  week  to  amuse  and  instruct  them. 


208        REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

The  children  complain  of  being  kept  out  of  school  and  thus  getting  behind  their 
classes.  We  try  to  get  some  one  to  instruct  them  and  stimulate  their  interest  in 
the'right  kind  of  reading.  One  child  was  kept  in  bed  six  months,  at  the  end  of 
which^time  all  symptoms  and  signs  of  the  disease  were  absent. 

Some  of  the  home  surroundings  are  such  that  it  is  impossible  for  the  family 
to' look  after  the  patient  properly;  a  convalescent  home  was  started  for  tliis  type 
of  children  with  heart  disease,  and  they  are  able  to  remain  in  bed  as  long  as  is 
necessary.  We  hope  eventually  to  have  somebody  teach  them  a  quiet  trade 
fitted  to  their  condition.  Tailoring  would  be  satisfactory  if  the  hygienic  condi- 
tions of  the  shops  were  good.  The  important  thing  to  remember  is  that  they 
must  have  supervision  long  after  they  are  apparently  well. 

A  girl  of  ten  years  with  endocarditis  applied  to  the  Children's  Medical  Depart- 
ment for  treatment  on  December  26,  1911.  She  was  a  pale,  restless  child,  several 
pounds  under  weight,  with  dark  circles  under  her  eyes,  and  the  physical  examination 
showed  a  leak  in  the  aortic  and  mitral  valves.  She  was  put  to  bed.  The  social 
worker  discovered  the  child  often  read  sensational  literature  until  11  o'clock  at 
night.  She  told  her  she  must  stop  if  she  wanted  to  get  well,  and  started  her  interest 
in  wholesome  reading  and  better  living.  After  four  months'  care  she  was  able 
to  return  to  school,  having  gained  13  pounds  and  12  ounces  in  weight. 

Katherine  Varden,  aged  five  years,  was  brought  to  the  clinic  by  her  mother. 
Examination  revealed  the  presence  of  gonorrheal  vaginitis.  The  child's  condition 
was  really  pitiable.  Her  mother  reported  that  the  father  and  two  men  lodgers 
had  had  gonorrhea. 

A  home  visit  was  made  that  afternoon,  and  the  nature  of  the  disease  explained. 
The  mother  got  rid  of  the  lodgers  at  once  and  started  to  clean  the  house.  The 
father  was  interviewed,  and  advised  to  go  to  a  medical  clinic  for  treatment,  which 
he  did  the  next  day.  The  sanitary  conditions  were  very  bad,  an  earth-closet  in 
the  rear  of  the  house  having  a  most  offensive  odor,  and  the  cellar  being  partly 
filled  with  ^water. 

A  letter  was  written  to  the  Board  of  Health,  and  inside  of  two  days  they  had 
eliminated  the  offensive  unsanitary  conditions. 

The  mother  continued  to  bring  the  patient  to  the  clinic  until  the  discharge 
ceased. 

This  child  was  under  observation  from  September  5,  1911,  up  to  May  15, 
1912,  and  has  had  no  discharge  since  February  1,  1912. 

The  sample  cases  cited  above  serve  only  to  illustrate  the  infinite  possibilities 
of  the  work  and  are  picked  at  random  from  those  coming  to  our  clinic  every  day. 

Mb.  Folks:  This  is  certainly  a  most  interesting  paper.  The  discussion 
•will  be  opened  by  Miss  Helen  M.  Glenn,  Head  Worker  of  the  Social  Service 
Department  of  the  University  Hospital  of  Philadelphia. 

DISCUSSION  ON  DR.  FRITZ  TALBOT'S  PAPER 
Miss  Helen  M.  Glenn  :  It  is  hard  to  determine  whether  we  can  compute  the  value  of  a  baby's 
life  in  dollars  and  cents,  but  we  certainly  can  compute  the  cost  of  a  baby's  sickness  to  a  hospital  in  re- 
lation to  the  emplojTnent  of  skilled  medical  treatment  and  nursing  care.     If  our  efforts  will  prevent 
this  economic  waste,  they  are  of  value,  but  to  save  the  social  waste  is  of  even  greater  importance.    So  it 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       209 

has  been  that  in  the  past  ten  years  many  hospitals  in  larger  cities  have  opened  social  service  departments 
to  supplement  the  medical  work  and  to  make  permanent  the  results  already  attained  through  medical 
care. 

In  addition  to  what  Dr.  Talbot  has  said  I  want  to  outline  several  other  opportunities  these  de- 
partments may  grasp  in  relation  to  child  hygiene.  A  hospital  makes  an  excellent  point  of  departure 
for  children's  work,  especially  if  the  doctor  includes  social  work  as  part  of  his  clinical  routine.  If  the 
mother  sees  the  social  worker  at  the  hosi)ital,  her  visits  to  the  home  become  a  natural  extension  of  the 
hospital  treatment.  This  gives  the  social  worker  an  opportunity  to  do  preventive  work  not  only  for 
the  child,  which  has  been  in  the  hospital  or  attemling  the  dispensary,  but  for  the  other  children  in 
the  home  who  are  liable  to  the  same  diseases.  It  seems  hardly  necessary  to  emphasize  the  fact  that 
most  of  the  sickness  in  any  children's  medical  ward  is  from  preventable  diseases,  and  if  diseases  are 
preventable,  they  are  apt  to  be  recurrent.  Practically  every  hospitjxl  can  show  record  after  record  of 
children  having  come  to  the  hospital  again  and  again.  One  hospital  had  a  child  five  months  in  the 
ward.  Two  days  after  her  discharge  she  was  brought  back  fatally  ill  with  a  prevcnt^ible  disease.  Out 
of  G5  cases  of  disease  studied  last  July  in  the  Children's  Medical  Dispensary  of  the  University  Hos- 
pital, at  least  CO  cases  were  due  to  preventable  di.seases.  Twenty  were  cases  of  chronic  indigestion,  7 
of  acute  gastritis,  etc. 

In  regard  to  follow-up  work  of  the  child  who  has  been  in  the  hospital,  we  find  that  in  probably 
50  per  cent,  of  the  eases  at  the  University  Hospit;il  there  is  some  <lefinite  social  condition  that  will 
immensely  afject  the  convalescent  child.  In  the  hospital  he  has  had  regular  hours,  regidar  treatment, 
regular  meals,  etc.  If  he  goes  back  into  an  insanitary  home,  the  result  is  almost  sure  to  be  disastrous 
unless  there  is  somebody  there  to  extend  and  carry  on  the  hospital  treatment.  Our  effort  is  always  to 
visit  the  home  immediately  after,  if  possible  immediately  before,  the  child's  discharge,  in  order  that  this 
critical  tran.saction  period  may  be  made  as  safe  for  the  child  as  possible. 

Dr.  Talbot  has  pointed  out  that  the  social  worker  should  be  continually  alert  to  neighborhood 
conditions,  as  well  as  to  those  in  the  family  she  is  visiting.  In  one  case  that  we  handled  the  social  worker 
was  visiting  a  child  with  a  bad  eye  condition,  which  required  constant  and  regular  treatment.  She 
found  in  the  neighborhood  a  baby  with  deformed  limbs  and  another  with  facial  eruption  and  discharg- 
ing ears.  A  timid  child  was  blind  in  one  eye  and  the  other  eye  was  in  bad  condition.  This  was  on  a 
street  shut  off  from  the  central  part  of  the  city.  In  such  instances  as  this  the  social  worker  has  an  op- 
portunity to  carry  on  a  health  campaign  for  the  entire  neighborhood,  as  well  as  for  the  family  in  which 
she  is  interested. 

All  of  us  who  are  doing  hospital  social  service  work  recognize  that  it  may  be  a  temporary  thing. 
Whether  we  should  act  as  a  private  organization  or  whether  we  should  be  attached  to  a  larger  mimicipal 
movement  for  child  hygiene  is  an  open  question.  Certainly  for  the  present  the  hospital  social  service 
department  is  supplying  a  pressing  need. 

Mr.  Folks:  The  subject  of  hospital  social  service,  especially  in  relation  to 
children,  is  now  open  for  discussion  for  a  few  minutes. 

Dr.  Huntington:  The  thing  which  has  impressed  me  most  about  the  work  that  Dr.  Talbot  is 
doing,  as  I  have  seen  it  in  Boston,  is  the  follow-up  work  of  their  clinic  nurses  and  the  effective  manner 
in  which  they  secure  the  cooperation  of  the  various  other  agencies  doing  work  among  children. 

Mrs.  M.J.  M.\gee,  Head  Social  Worker  of  the  Pennsylvania  Hospital,  Philadelphia:  I  was 
especially  interested  in  Dr.  Talbot's  remarks  concerning  the  heart  cases.  This  is  one  of  the  most 
serious  problems  we  have  to  deal  with  in  our  social  service  work  at  the  Pennsylvania  Hospital.  We 
are  trying  to  have  the  families  move  the  invalid  member  to  the  first  floor  of  the  house,  but  this  seems 
difficult  to  accomplish.     I  would  like  to  ask  Dr.  Talbot  how  long  he  follows  up  the  heart  cases. 

Dr.  Talbot:  That  is  a  difficult  question  to  answer.  We  have  been  following  up  some  cases  very 
closely  for  the  past  seven  months,  and  I  think  we  have  several  cures;  but  we  must  continue  them  under 
observation  for  at  least  a  year  before  we  can  say  definitely  that  they  are  cured.  It  is,  indeed,  a  pathetic 
sight  to  see  the  boys  and  girls  of  from  three  to  sLx  years  of  age  that  come  into  children's  wards  for  heart 


210       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

conditions— the  anxious  expression,  the  blue  lips,  the  panting  for  breath,  mark  them  as  intense  sufferers, 
and  yet  they  are  the  best  little  sufferers  in  the  world.  It  has  seemed  heretofore  that  the  limitation  of 
our  observation  of  these  cases  made  it  almost  impossible  to  do  anything  for  them.  Our  present  scheme 
promises  much,  and  if,  by  any  chance,  we  can  cure  50  to  60  per  cent,  of  them,  I  think  we  will  have  real 
reason  to  be  happy.  What  we  consider  a  cure  is  the  absence  of  temperature,  a  heart  of  normal  size, 
and  a  pulse  of  normal  rate.  That  is  as  far  as  we  are  trying  to  go  at  present.  I  believe  a  few  hundred 
dollars  applied  to  the  early  treatment  of  these  cases  will  save  thousands  of  dollars  in  then-  treatment 
in  later  life.  I  believe,  furthermore,  that  a  large  proportion  of  the  chronic  cardiac  cases  in  adult  life 
have  their  beginning  in  childhood  and  can  to  a  great  extent  be  prevented  by  what  we  are  endeavoring 
to  do. 

Dr.  Woodward:  Do  you  think  there  is  any  value  in  extending  the  work  to  those  cases  which  are 
absolutely  helpless? 

Dr.  Talbot:  Only  a  certain  amount  of  work  can  be  done,  and  we  have  a  limited  amount  of 
money  to  spend  on  it.  It  has  seemed  to  us,  therefore,  that  it  would  be  better  to  take  the  cases  which 
had  not  already  become  too  far  advanced,  as  neglect  of  such  cases  might  make  them  hopeless,  whilst 
proper  care  might  result  in  their  cure. 

Mr.  Folks:  Dr.  Hart  not  yet  having  arrived,  I  will  ask  Dr.  Schereschewsky 
if  he  is  prepared  to  open  a  discussion  of  the  subject  of  Home  Placing  versjis  the 
Institutional  Care  of  Babies. 

Dr.  Schereschewsky:  I  am  willing  to  do  so,  although  I  am  ignorant  of  the  contents  of  Dr. 
Hart's  paper.  I  possess  only  a  very  general  knowledge  of  the  subject.  However,  there  are  certam 
facts  one  can  mention  which  operate  disadvanUgeously  to  the  institutional  care  of  infants  in  this  country. 
The  mortality  rate  is  extremely  high  in  such  institutions.  This  is  possibly  due  to  a  variety  of  condi- 
tions. We  have  very  few  model  institutions  for  the  care  of  infants.  The  majority  of  them  are  over- 
crowded, but  the  most  important  cause  of  their  high  infant  death-rate  is  a  lack  of  wet-nurses.  I  abso- 
lutely agree  with  Professor  Schlossman's  statement  that  to  have  an  institution  for  the  care  of  infanU 
without  an  adequate  number  of  wet-nurses  is  just  as  inconceivable  as  a  hospital  devoted  to  surgical 
cases  without  an  operating  room. 

In  most  institutions,  also,  the  regulations  governing  the  control  of  contagious  diseases  are  inade- 
quate. Such  diseases  as  trachoma  and  gonorrheal  ophthalmia  sometimes  gain  remarkable  headway, 
and  measles  and  whooping-cough  invariably  attack  every  child  not  having  had  these  diseases  previously, 
before  the  institutional  epidemic  ends. 

From  conversation  with  Dr.  Hart  I  know  that  he  is  an  advocate  of  the  home  placing  of  infants. 
This  system,  when  intelligently  supervised,  has  been  productive  of  excellent  results.  In  fact,  the  mor- 
tality amongst  infants  thus  cared  for  is  very  much  lower  than  that  which  obtains  in  the  best  of  our  in- 
stitutions. If  it  were  impracticable  to  improve  the  institutional  care  of  children,  J  would  say  by  all  means 
increase  the  number  of  children  placed  in  homes  to  the  utmost  degree.  At  present,  however,  institutions 
are  a  necessity,  and  will  be  for  years  to  come.  Furthermore,  it  is  not  impracticable  at  all  to  improve 
them,  nor  to  care  for  infants  satisfactorily  in  them.  All  that  is  necessary  to  accomplish  this  is  to  possess 
properly  constructed  buildings  and  adequate  executive,  nursing  and  medical  supervision,  together  with 
a  sufficient  number  of  wet-nurses  to  insure  breast-feeding,  in  part,  at  least,  for  every  infant  in  the  in- 
stitution. To  secure  these  wet-nurses  is  not  as  difficult  as  one  might  think.  It  is  a  common  thing  in 
Germany  to  find  a  wet-nurse  able  to  suckle  two  children  besides  her  own,  and  cases  are  on  record  where 
the  milk  secretion  in  certain  very  productive  wet-nurses  has  been  sufficient  to  provide  for  three  per  day 
in  addition  to  her  own.  If,  therefore,  a  conscientious  effort  was  made  to  provide  wet-nurses,  we  would 
be  able,  after  a  while,  to  do  away  with  all  artificial  feeding,  which  has  been  the  greatest  menace  to  the 
lives  of  infants  in  institutions. 

Then,  too,  there  has  not  been  sufficient  attention  paid  to  the  matter  of  construction  of  such  in- 
stitutions in  relation  to  economy  of  space,  convenience  of  arrangement,  and  sanitary  efficiency— quite 


PROCEEDINGS  OF  COXFEREXCE  OX  INFANT  HYGIENE       211 

the  contrary,  in  fact.  These  institutions  are  so  ill  adapted  to  their  purpose  that  they  practically  con- 
tribute to  the  rapid  spread  of  the  infectious  diseases  which  may  develop  in  them. 

There  is  an  almost  universal  tendency,  also,  to  overtax  the  capacity  of  institutions,  and  this 
crowding  is  one  of  the  most  potent  factors  in  the  high  death-rate.  It  should  be  perfectly  possible,  by 
the  correction  of  these  and  other  similar  defect.s,  to  have  a  death-rale  in  such  institutions  that  would 
compare  favorably  with  that  which  obtains  in  families. 

The  institutional  care  of  infants  has  the  ativantage  of  being  the  more  economical,  which  makes 
the  dependent  child  less  of  a  tax  upon  the  community  at  large.  The  community  is  rightly  taxable  for 
the  proper  care  of  its  dependent  children,  but  it  is  the  duty  of  the  slate  to  provide  such  care  at  the  least 
possible  expense  commensurate  with  good  results.  If  we  find  that  such  results  are  possible  through  the 
proper  institutional  care  of  infants,  as  I  believe  they  may  be,  then  it  becomes  necessary  for  the  state 
to  provide  such  institutions. 

Mh.  Folks:  Do  you  know  how  many  in.stitutions  there  are  which  measure  up  to  this  ideal  con- 
dition which  you  speak  of.  Dr.  Schcrcschewsky? 

Dr.  Schereschewskt:  As  I  said,  I  disclaim  great  familiarity  with  this  subject,  but  there  are 
some  abroad. 

Mr.  Folks:   Could  you  name  any  in  England  or  (ierniany? 

Dr.  Screreschewsky:  I  cannot  name  any  in  Euglaud,  though  I  think  there  arc  several  in  Ger- 
many, and  the  name  of  the  Resident  Zeugnis-IIeiin  occurs  to  me.  The  jjrinciple  is  the  s.anu-  whether 
you  have  a  larger  or  a  smaller  institution.  The  institutional  care  of  children  does  not  call  for  any  com- 
plicated conditions.  Of  course,  I  am  not  speaking  from  actual  figures,  but  on  general  principles.  I 
would  say,  however,  that  any  institution  which  averages  a  per  capita  expenditure  of  $5  a  week  for  the 
care  of  its  infants,  including  the  cost  of  the  original  investment,  is  being  run  at  entirely  too  great  an 
expense. 

Mr.  Folks:  Of  course,  they  are  boarded  out  at  very  much  less  than  that,  and  (juite  successfully, 
so  that  I  am  not  quite  sure  that  an  analysis  of  the  figures  would  show  any  substantial  difference  in  the 
cost  of  the  two  systems,  and  what  dilfcrence  there  is  might  be  found  to  be  in  favor  of  family  placing. 

Dr.  Scuereschewsky:  There  is  this  di.sadvantage  about  the  family  placing  of  children,  and  that 
is  that  you  do  not  have  the  constant  medical  supervision  that  one  has  in  institutions.  On  the  other 
hand,  there  are,  of  course,  many  possible  compUcations  in  the  institutional  system  which  do  not  obtain 
in  the  placing-out  system. 

Mrs.  Cooper,  San  Francisco:  I  have  had  an  opportunity  to  visit  institutions  for  the  care  of 
children  in  many  countries  of  the  world.  In  Moscow  I  visited  an  institution  which  cared  for  1000  babies, 
each  with  its  own  wet-nurse.  In  Russia  the  crime  of  abortion  is  practically  unknown.  At  the  same 
time  it  is  not  consi<!ered  specially  disgraceful  for  a  mother  to  have  a  child  born  out  of  wedlock.  The 
result  is  that  there  are  a  great  many  children  given  over  to  the  care  of  the  state.  This  has  made  neces- 
sary the  establishment  of  great  foundling  asylums,  such  as  those  in  St.  Petersburg  an<l  Moscow.  All  the 
babies  are  wet-nursed,  and  they  are  kept  in  the  asylums  until  they  are  sent  out  by  order  of  the  doctors 
to  "mothers"  in  the  provinces,  that  is,  to  mothers  who  have  lost  their  own  babies,  or  are  willing  to  take 
another  baby  besides  their  own.  The  maintenance  of  these  children  is  paid  in  part  out  of  the  treasury 
of  the  state  until  the  child  is  able  to  go  to  scJiool.  In  this  way  Russia  has  saved  about  1,000,000  citizens 
in  a  hundred  years  in  these  two  asylums. 

The  difficulty  in  this  country  would  be  that  of  securing  a  sufficient  number  of  wet-nurses.  We 
have  an  institution  in  San  Francisco  in  which  we  care  for  babies  without  wet-nurses  and  succeed  very 
well.  We  have  only  about  .'SO  babies  under  our  care,  at  a  per  capita  cost  of  less  than  $10  a  month.  We 
attribute  our  success  to  a  sufficient  amount  of  fresh  air  and  proper  medical  care.  I  believe  something  may 
be  said  against  the  boarding  out  of  children,  especially  in  regard  to  the  lack  of  control.  They  are  usually 
under  the  direction  of  a  paid  inspector,  who  makes  his  visits  about  once  a  week.  The  foster  mother 
soon  knows  when  to  expect  him.  She  often  sees  him  coming  and  hastens  to  get  things  into  attractive 
shape  for  the  inspection.  In  the  interval  we  are  not  absolutely  sure  what  happens  to  the  baby.  But 
in  a  small  institution,  where  j'ou  have  good  nurses  who  have  the  care  of  the  children  night  and  day 
and  adequate  medical  attention,  the  baVjies  certainly  get  the  proper  care. 


212       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Dr.  Schereschewsky:  I  would  like  to  ask  what  is  your  death-rate  in  that  San  Francisco  institu- 
tion? 

Mrs.  Cooper:  The  rate  is  very  much  smaller  than  for  the  city  at  large.  I  cannot  state  the  exact 
percentage.  The  institution  is  maintained  for  the  care  of  babies  whose  mothers  are  obliged  to  work  to 
support  themselves,  and  who,  therefore,  cannot  nurse  them  in  the  home.  \Ve  take  the  baby  at  any  time 
from  the  time  it  is  born.  The  mother  pays  $8  a  month  if  she  is  able,  and  if  not,  we  take  care  of  the 
child  until  she  is  able.  The  baby  undergoes  a  medical  examination,  so  that  we  may  know  whether  it 
is  sufl'ering  from  anything  that  would  infect  the  other  babies.  If  it  has  no  contagious  or  infectious 
disease,  we  bring  it  in.     We  would  not  accept  a  baby  that  could  not  be  kept  with  the  other  children. 

Dr.  Schereschewsky:  But  any  institution  which  cares  for  foundlings  or  illegitimate  children 
must  be  prepared  to  accept  them  under  all  conditions,  otherwise  the  institution  is  not  performing  its 
economic  function. 

Miss  Ellen  C.  Babbitt:  I  agree  with  Dr.  Schereschewsky  that  these  institutions  should  be  so 
organized  as  to  accept  all  those  that  apply,  and  that  there  should  be  no  separation  of  the  child  from 
the  mother.  Such  separations  at  the  doors  of  these  institutions  mark  the  very  beginning  of  infant 
mortality.     Foundling  asylums  have  no  right  to  exist. 

Mrs.  Cooper:  What  is  the  mother  to  do  if  she  has  not  a  dollar  to  her  name  and  has  a  baby  which 
she  must  care  for? 

Miss  Babbitt:  The  Charities  Aid,  in  New  York  City,  has  been  demonstrating  very  clearly  what 
the  mother  should  do.  Miss  Mason,  of  that  organization,  is  here,  and  I  should  much  prefer  to  have 
her  explain  the  work.  The  Aid  has  made  it  its  business  to  secure  work  for  the  mother  where  she  can 
keep  her  child  with  her.  In  other  words,  they  are  attempting  to  prevent  the  existence  of  such  things  as 
foundlings.  Mr.  Folks  is  interested  further  in  making  inquiry  as  to  what  the  social  service  in  the  hos- 
pitals is  doing  along  this  line.  They  are  going  to  the  hospitals  and  to  other  institutions  that  send  out 
nurses,  and  making  a  study  of  the  women  who  are  \-isited  by  the  nurses  before  it  is  necessary  for  the 
mother  to  go  to  the  hospital.  In  Baltimore  they  attempt  to  prevent  the  separation  of  the  mother  and 
the  child  through  the  medium  of  a  "next  friend,"  who  endeavors  to  enlist  the  interest  of  the  various 
charitable  agencies  in  securing  her  a  position  to  which  she  can  take  her  child. 

It  is  a  common  experience  in  New  York  for  mothers  to  be  retained  in  hospitals  but  ten  days  after 
confinement.  In  many  of  these  hospitals  the  baby  has  been  weaned  by  that  time.  The  baby  is  then 
on  the  bottle,  and  the  mother  has  no  particular  reason  for  wanting  to  keep  it  with  her.  Consequently 
she  goes  to  a  foundling  asylum,  tells  her  story,  and  the  baby  is  taken  from  her. 

Miss  Mason,  of  the  State  Charities  Aid  Society,  New  York  City:  Our  work  consists  in  helping 
out  the  mother  who  does  not  know  what  to  do  with  her  bal)y.  She  is  encouraged  to  keep  it  with  her,  and 
is  referred  to  some  private  place  where  she  can  stay  until  she  is  able  to  plan  something  for  herself. 


Second  Session — Wednesday,  May  22,  8  P.  M. 

Presiding  Officer: 

Dr.  Joseph  S.  Neff,  Director  of  the  Department  of  Public  Health  and 
Charities  of  Philadelphia. 

1.  The  Regulation  of  Midwifery: 

Dr.  James  L.  Huntington,  of  Boston.  Discussion  to  he  opened  by  Dr. 
Mary  Sherwood,  Chairman  of  the  Committee  on  Midwifery  of  the  Ameri- 
can Association  For  Study  and  Prevention  of  Infant  Mortality. 

2.  The  Control  of  M.vrriagf.s  of  the  Unfit: 

Dr.  Henry  H.  Goddard,  Director  of  Research,  The  Training  School  for 
Backward  and  Feeble-minded  Children,  Vineland,  X.  J.  Discussion  to 
be  opened  by  Dr.  Charles  W.  Burr,  Professor  of  Mental  Diseases  in  the 
University  of  Pennsylvania. 

3.  The  Effect  of  Housing  Upon  Infant  Mortality: 

C.-E.  A.  Winslow,  Professor  of  Biology,  College  of  the  City  of  New  York. 
Di.scussion  to  be  opened  by  Mr.  Bernard  J.  Newman,  Secretary  of  the  Phila- 
delphia Housing  Commission. 


DR.  JOSEPH  S.  NEFF 

Director  of  the  Departmeat  o(  Public  Healtli  and  Charities  of  Philadelphia,  Presiding 


Ladies  and  Gentlemen:  I  have  sometimes  been  accused,  as  presiding  officer, 
of  talking  too  much,  and  of  delving  into  the  problems  that  are  about  to  be  discussed. 
The  subject  of  the  first  paper  of  the  evening  tempts  me  so  much  that  in  self-de- 
fense I  shall  hasten  to  the  pleasurable  privilege  of  presenting  Dr.  James  L.  Hunt- 
ington, of  Boston,  who  will  speak  on  "The  Regulation  of  Midwifery." 


THE  REGULATIOX  OF  MIDWIFERY 
BY  DR.  JAMES  L.  HUNTINGTON 


Your  committee  has  asked  me  to  speak  on  the  Regulation  of  Midwifery. 

Midwifery  is  defined  in  the  Century  Dictionary  as  "The  practice  of  obstetrics; 
the  practice  of  assisting  women  in  childbirth. " 

So  as  to  avoid  any  possible  misunderstanding,  I  am  using  midwifery  as  sjTiony- 
mous  with  obstetrics,  and  shall  speak  of  the  obstetric  problems  in  our  American 
cities,  where  we  have  a  large  foreign  population  with  which  to  contend. 

il3 


214       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Now,  if  we  look  at  the  obstetrics  as  conducted  in  the  foreign  quarters  of  any 
of  our  large  cities  we  are  at  once  brought  face  to  face  with  two  classes  of  practitioners 
— the  midwife,  usually  dirty  and  untrained,  and  her  competitor  or  accomplice, 
the  doctor,  usually  ignorant  and  often  unscrupulous.  It  is  of  these  two  classes  of 
practitioners  I  wish  to  speak. 

But  as  we  have  used  the  word  foreign  in  connection  with  those  that  employ 
the  midwife,  let  us  for  a  few  moments  retrace  the  steps  of  the  immigrant  and  see 
the  midwife  at  home. 

In  Europe,  obstetrics  has  always  been  in  the  hands  of  midwives,  and  the 
necessity  for  the  trained  midwife  was  recognized  as  soon  as  higher  medical  knowl- 
edge was  considered  essential  for  the  practice  of  medicine.  Let  us  take  Germany 
as  an  example  of  a  country  with  a  well-established  midwife  system,  realizing  that 
what  is  true  of  Germany  is,  with  only  slight  variations,  true  of  the  whole  of  Europe. 

In  Germany  the  midwife  is  carefully  trained  by  the  Government  in  well-estab- 
lished Kliniks,  usually  by  universitj'  professors. 

Midwives  are  rigidly  examined  before  they  are  allowed  to  practice.  Their 
exact  duties  and  limitations  are  carefully  outlined  by  law.  Before  starting  in 
practice  the  mid\\-ife  must  report  to  the  medical  inspector  in  charge  of  that  locality, 
and  after  he  has  passed  upon  her  credentials,  she  will  be  allowed  to  go  to  work, 
but  she  is  constantly  under  his  supervision,  and  should  she  neglect  her  duty,  or 
disobey  his  instructions,  she  is  .subject  to  fine  or  imprisonment.  Not  only  that, 
but  she  must  report  at  once  any  abnormal  symptoms  occurring  in  the  condition  of 
any  of  her  patients  to  a  physician,  and  should  he  fail  to  respond  to  her  summons,  he 
is  subject  to  punishment. 

In  considering  the  Continental  midwife  and  her  work,  we  must  remember 
the  high  standing  of  European  physicians.  The  standard  of  education  required 
before  they  are  permitted  to  practice  is  so  high  that  impostors  and  charlatans,  and, 
to  a  lesser  degree,  dishonorable  physicians,  are  excluded.  Thus  it  is  that  the  mid- 
wife, when  she  summons  medical  aid,  must  necessarily  call  upon  a  trained  prac- 
titioner. 

Then  we  must  also  bear  in  mind  that  in  European  coimtries  laws  on  the  statute 
books  are  enforced  without  the  slightest  regard  for  local  popular  sentiment,  so  that 
it  is  next  to  impossible  for  the  midwife  to  violate  the  law  and  practice  outside  of 
her  narrow  limits  without  being  punished. 

But  in  spite  of  this  complete  system,  Germany  today  is  seriously  in  doubt 
as  to  the  worth  of  her  midwife  system.  Many  obstetricians  feel  that  just  as  long 
as  the  midwife  is  tolerated,  just  so  long  puerperal  fever  will  reap  its  yearly  harvest, 
and  each  year  thousands  of  mothers  and  new-born  babies  will  yield  up  their  lives 
unnecessarily  as  a  result  of  the  flaws  and  fallacies  in  the  midwife  system. 

In  England  we  find  an  entirely  different  story.  True,  the  midwife  has  always 
flourished  there,  but  the  Government  regulation  is  of  very  recent  date.  The  mid- 
wives  were  so  numerous,  and  the  trained  midwives  so  very  few,  that  earlj'  in  the 
present  century  tremendous  pressure  was  brought  to  bear  on  Parliament,  and  the 
present  midwife  system  was  adopted,  in  spite  of  very  vigorous  medical  opposition. 


PROCEEDINGS  OF  COXFEREXCE  OX  IXFAXT  IIYGIEXE       215 

In  comparing  the  system  with  America,  we  must  bear  in  mind  that  in  England, 
as  on  the  continent,  the  standing  of  the  medical  profession  is  high  and  the  standard 
uniform.  Quacks  are  not  countenanced,  and  unscrupulous  medical  men  are  com- 
paratively few. 

The  result  of  this  new  system  in  England  has  been  very  curious  and  interesting. 
The  obstetricians,  of  all  the  medical  men  alone,  urged  the  passage  of  the  Midwife 
Bill  because  they  saw  the  worst  results  of  the  old  regime  and  they  felt  that  any 
change  must  be  an  improvement.  The  general  practitioner  fought  the  bill.  Now 
we  see  the  tables  turned;  for  the  most  part  the  general  practitioners  are  in  favor 
of  the  changed  conditions.  The  midwife  works  with  the  general  i)ractitioncr  and 
saves  him  much  wearisome  and  unprofitable  work.  The  general  community  is 
probably,  at  the  present  time,  better  off,  because  midwives  were  numerous  and 
very  dirty,  and  now  they  are,  comi)arativeIy  speaking,  clean.  IJtit  the  obstet- 
ricians are  feeling  considerable  regret,  for  they  find  that  England  is  satisfied  with 
the  midwife  instead  of  the  physician,  which  must  steadily  make  for  a  lower  ob- 
stetric standard. 

One  member  of  the  ]\lidwives  Board  for  1!)I1,  Sir  George  Fordham,  states  in  no 
uncertain  terms  that  all  the  normal  midwifery  of  the  country  should  be  in  the  hands 
of  the  midwives,  and  the  medical  profession  act  merely  as  consultants  in  emer- 
gencies. Deprived  of  the  bulk  of  normal  oi)stetrics  of  today,  how  can  the  English 
physician  of  the  future  be  prepared  competently  to  care  for  the  emergencies?  The 
lowering  of  the  obstetric  standard  nuist  ultimately  react  on  the  infant  welfare  of 
the  future. 

As  the  situation  we  are  facing  in  this  country  is  not  so  much  the  midwife 
question  as  the  question  of  poor  obstetrics  in  general,  it  is  interesting  to  note  the 
recent  figures  of  Chalmers,  in  Glasgow,  where  the  physicians  are  good,  and  the 
nurses  and  midwives  without  proper  training  or  supervision.  He  found  that 
puerperal  fever  was  occurring  in  the  practice  of  midwives  and  nurses  at  twice  the 
rate  which  obtained  in  the  practice  of  cjualified  practitioners  when  they  had  charge 
of  the  patient  from  the  beginning.  In  this  country,  what  little  investigation  has 
been  accomplished  has  usually  proved  that,  in  this  regard,  the  midwives  were  no 
worse  than  the  doctors  with  whom  they  were  in  competition.  This  has  been  used 
as  an  argument  in  favor  of  the  midwives.  Does  it  not,  however,  merely  show  the 
frightful  level  to  which  obstetric  jiractice  in  America  has  been  allowed  to  sink? 

Professor  Williams,  of  Johns  Hopkins,  has  recently  proved  that  obstetrics 
is  shamefully  neglected  in  most  of  our  medical  schools,  and  that  even  the  large 
niiijority  of  students  in  our  best  schools,  at  the  time  of  graduation,  are  not 
sufBciently  trained  properly  to  conduct  a  case  of  normal  labor  on  their  own  re- 
sponsibility. 

As  we  look  at  the  history  of  obstetrics  in  America  we  do  not  find  any  uniform 
standard.  The  situation  differed  probably  in  each  of  the  thirteen  colonies,  and 
now  we  have  a  different  story  in  each  State  of  the  Union. 

Let  us  see  what  has  been  the  history  of  midwifery  in  Massachusetts,  and  how 
the  problem  has  been  treated  down  to  the  present  time. 


216       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

That  the  midwife  was  the  chief  practitioner  of  obstetrics  in  Massachusetts 
in  Colonial  times  we  judge  from  the  following  paragraph,  written  by  a  Boston 
physician  in  IS'-ZO:  "Among  ourselves  it  is  scarcely  more  than  half  a  century  since 
females  were  almost  the  only  accoucheurs.  It  was  one  of  the  first  and  happiest 
fruits  of  improved  medical  education  in  America  that  they  were  excluded  from 
practice,  and  it  was  only  by  the  united  and  persevering  exertions  of  some  of  the 
most  distinguished  individuals  our  profession  has  been  able  to  boast  that  this  was 
effected. "  So  we  see  that  until  about  1770  midwives  flourished  in  Massachusetts, 
but  that  from  then  on  they  disappeared  from  practice,  so  that  the  mere  proposal 
of  one  coming  to  Boston  to  practice  brings  out  a  forceful  pamphlet  on  the  midwife 
question. 

When  the  midwife  came  to  Boston,  and  how  she  flourished  in  other  parts  of 
Massachusetts,  it  is  not  difficult  to  imagine.  She  came  with  her  fellow  country- 
men from  Austria,  from  Russia,  and  from  Italy,  and  working  among  her  o^\'n 
people,  she  was  not  noticed  until  gradually  her  position  became  established  and 
she  gained  recognition  in  that  the  laws  for  registration  of  births  recognized  her 
existence.  However,  when  the  Board  of  Registration  in  Medicine  and  laws  govern- 
ing the  practice  of  medicine  were  passed  in  1894,  the  midwife  was  not  mentioned, 
and  by  such  omission  the  Supreme  Court  of  INIassachusetts  has  decided  that  mid- 
wives  are  excluded  from  the  practice  of  their  profession,  and  midwives  have  been 
fined  for  violating  the  law. 

But  this  does  not  mean  that  Massachusetts  is  free  from  midwives.  Careful 
search  reveals  them  at  work  in  every  city  where  the  foreigners  form  a  large  proportion 
of  the  population.  But  because  of  the  enforcement  of  the  law,  feeble  as  it  has  been, 
the  midwife  is  not  conspicuous.  How  many  midwives  there  are,  and  how  active, 
it  is  very  hard  to  say;  careful  investigation  has,  however,  revealed  some  150  in 
more  or  less  active  practice.  And  in  five  cities,  where  they  are  unchecked  in  their 
activities,  in  1909  they  attended  2138  births,  or  an  average  of  15  per  cent,  of  all 
the  births  in  those  five  cities. 

In  Boston,  during  the  year  1911,  not  a  single  birth  was  reported  to  the  city 
registrar  by  a  midwife.  But  this  does  not  mean  that  Boston  is  free  from  midwives. 
They  exist,  unfortunately,  but  they  are  closely  connected  with  physicians  who  re- 
port the  births  for  the  midwives.  Perhaps  to  some  this  would  seem  an  ideal 
solution  of  the  problem — the  midwife  conducting  the  normal  case,  the  physician 
assuming  the  responsibility  and  exercising  a  supervision  over  the  midwife.  This 
might  be  ideal  in  foreign  countries,  but  here  in  America  the  physician  who  will 
work  with  the  midwife  is  not  usually  of  such  high  standing  as  to  promise  much  for 
the  welfare  of  the  patients. 

In  view  of  this,  in  the  recent  Prompt  Birth  Return  Law  which  has  just  been 
passed  in  INIassachusetts,  there  is  a  clause  requiring  the  physician  or  midwife 
signing  the  report  to  state  whether  or  not  he  or  she  was  actually  present  at  the 
birth.  Thus  we  hope  gradually  to  secure  evidence  which  will  make  it  possible 
to  prevent  the  midwives  from  continuing  the  practice. 

But  in  such  a  matter  as  this  legislation  is  powerless.     The  keynote  is  education. 


PROCEEDLXGS  OF  COXFEREXCE  OX  IX  FA  XT  HYGIEXE       217 

We  must  educate  the  general  public  to  realize  the  necessity  for  good  obstetrics,  and 
place  the  means  of  obtaining  it  at  the  disposal  of  all,  and  then,  with  or  without 
laws  against  the  midwife,  she  will  disappear  from  our  cities. 

As  a  factor  in  this  campaign  of  education  a  well-conducted  maternity  dis- 
pensary is  of  tremendous  power.  Let  me  describe  the  working  units  of  such  an 
institution: 

A  few  rooms  in  a  congested  portion  of  the  tenement-house  district.  The 
patients  apply  for  treatment  as  .soon  as  they  wish,  but  the  earlier  the  better,  pref- 
erably as  soon  as  pregnancy  is  suspected.  As  soon  as  the  diagnosis  is  made  the 
patient  is  visited  by  a  .social  worker,  who  sees  to  it  that  the  jjatient  is  worthy  of 
charity,  or  else  that  a  nominal  fee  is  promised.  The  patient  returns  for  monthly 
conferences,  meanwhile  being  visited  by  a  district  nurse.  Should  an  abnormality 
or  any  deformity  be  discovered  the  j)atient  will  be  delivered  in  a  maternity  iiospital, 
but  if  all  is  normal,  in  her  ovni  home,  by  students  of  medicine  in  medical  school 
centers,  under  the  supervision  of  competent  instructors,  or  by  younger  physicians 
where  students  are  not  obtainable.  Such  an  institution  advertises  itself  and  edu- 
cates a  constantly  increasing  proportion  of  the  mothers  of  the  future. 

We  are  gradually  develoiting  the  details  of  such  a  system  in  Boston,  where  the 
Out-i)atient  Department  of  the  Lying-iu  Ilosjiital  has  for  many  years  cared  for 
more  than  10  per  cent,  of  all  the  births  in  the  city.  To  show  that  the  foreign 
population  will  come  to  such  a  hospital  I  have  collected  the  following  figures  from 
the  records  of  the  Pregnancy  Clinic  of  the  Boston  Lying-in  Hospital,  an  institution 
following  the  lines  of  prenatal  work  begun  by  the  Women's  INIunicipal  League. 

Of  the  last  1000  cases  that  have  ajjplied  for  treatment  in  our  Pregnancy  Clinic, 
83  per  cent,  were  foreign  born,  a  large  proportion  of  them  speaking  little  or  no 
Enghsh.  Of  these  1000  cases,  51  per  cent,  were  born  in  Russia  and  13  per  cent, 
in  Italy. 

Another  method  of  education  has  been  recently  started  by  the  Division  of 
Child  Hygiene,  Boston  Board  of  Health.  To  prevent  the  high  infant  mortality 
in  certain  of  the  most  congested  portions  of  Boston  the  scheme  was  adopted  last 
fall  of  sending  around  nurses  to  make  visits  in  the  homes  where  infant  deaths  had 
occurred  from  enteric  disorders  the  previous  year.  Where  these  nurses  found  that 
another  child  was  expected,  they  tactfully  began  a  campaign  of  education  by  ad- 
vising competent  hospital  care,  but  where  this  was  refused,  even  after  continued 
urging,  they  endeavored  to  keep  the  confidence  of  the  family,  in  spite  of  what  might 
ensue,  striving  to  give  prenatal  and  postnatal  care,  so  far  as  the  patient  would 
permit.  The  work  started  with  two  nurses,  but  it  has  been  so  successful  that  six 
nurses  are  now  at  work  in  greatly  increased  territory. 

There  is  another  method  of  education  which  might  be  afforded  these  ignorant 
immigrants,  and  that  is  to  place  in  their  hands  upon  arrival  in  this  country  a  state- 
ment of  the  true  facts  as  to  midwives  and  doctors,  explaining  that  these  terms  in 
America  are  not  necessarily  equal  to  their  known  European  value;  also  where  to 
apply  for  advice  in  case  of  illness. 

Let  us  briefly  see  what  has  been  done  elsewhere  in  America.     In  New  York 


218       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

City,  where  over  50,000  births  are  conducted  by  midwives  each  year,  the  problem 
has  seemed  too  stupendous  to  be  met  as  in  Massachusetts,  and  so  the  midwife 
has  been  recognized,  and  a  school  established  for  her  education,  and  laws  have  been 
passed  for  her  regulation  and  supervision. 

In  Pennsylvania,  until  1909,  there  was  no  law  controlling  the  midwives.  But 
in  that  year  such  a  law  was  passed.  Dr.  Newmayer,  having  had  charge  of  the 
working  of  this  law  in  Philadelphia,  has  come  to  the  conclusion  that  the  midwife 
is  not  an  economic  necessity.  He  believes  that  by  education  she  can  be  gradually 
eliminated.  Such  a  work  of  education  with  this  end  in  view  has  been  begun  in 
Pittsburgh  in  the  last  few  weeks.  Finding  that  some  5000  l^abies  were  born  every 
year  in  that  city  without  medical  attendance,  the  Pittsburgh  Maternity  Dispensary 
was  established  to  care  for  this  portion  of  the  population.  It  has  an  eiEcient  corps 
of  physicians,  nurses,  and  social  workers. 

To  summarize  the  regulation  of  midwifery  in  America,  we  have,  first  of  all, 
to  face  these  problems:  Obstetric  education  in  our  medical  schools,  the  midwife, 
and  the  ignorance  and  prejudice  of  the  immigrant  population.  Let  us  be  prepared 
to  meet  these  problems  with  eyes  open  to  the  facts.  Our  medical  schools  are  not 
giving  proper  framing  in  obstetrics.  The  general  public  is  not  awakened  to  the 
value  of  obstetrically  trained  physicians.  The  man  or  the  woman  who  is  to  take 
the  responsibility  of  obstetric  cases  must  be  prepared  to  cope  with  each  and  every 
emergency  which  may  occur  during  the  labor  or  the  puerperium — must  be,  in 
other  words,  an  obstetrician  thoroughly  trained  in  general  medicine  to  give  the 
best  results — to  give  the  attention  we  know  to  be  necessarj'.  Anything  less  than 
this  is  a  makeshift  and  a  substitution,  and  must  be  so  regarded  in  the  clear  light 
of  modern  science.  To  train  women  to  take  care  of  normal  cases  only  must  be 
fallacious,  for  who  is  to  make  the  diagnosis  and  be  sure  that  the  case  is  normal? 

Until  we  have  a  uniform  standard  of  medical  education  we  will  be  sure  to  find 
the  ignorant  physicians  summoned  by  the  midwife  in  trouble — the  better  trained 
doctors  will  not  be  called  upon — the  contrast  would  be  too  marked. 

It  hardly  seems  fair  to  punish  the  immigrant  mother  for  her  ignorance.  It 
hardly  seems  right  to  say  that  there  shall  be  two  standards  of  obstetrics — one  for 
the  poor  and  ignorant,  and  another  for  the  intelligent  and  well-to-do. 

Let  us  frankly  acknowledge  our  shortcomings  and  strive  to  educate  the  general 
public  to  realize  the  importance,  the  vital  importance,  of  obstetrics,  and  demand 
that  it  shall  be  thoroughly  taught  to  every  medical  student  before  he  is  allowed  to 
practice  medicine.  And  to  only  such  persons  as  have  adequate  training  shall  the 
full  responsibility  of  attending  obstetric  cases  be  intrusted. 

Then  let  us  teach  our  immigrants  that  in  America  we  believe  in  equality — 
as  near  as  possible  an  equal  chance  for  life,  health,  and  happiness  given  to  each 
child  at  birth,  a  single  standard  of  obstetrics  for  all. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       219 

DISCUSSION  ON  DR.  JAMES  L.  HUNTINGTON'S  PAPER 

Dr.  Mary  Sherwood,  Baltimore,  Md.:  It  seems  incredible  that  at  the  present  stage  of  our 
scientific  knowledge  a  problem  of  such  magnitude  as  this  problem  of  the  midwife  remains  to  be  faced. 
It  is  an  instance  of  an  evil  which  has  been  so  long  existent  that  we  have  come  to  regard  it  as  almost 
ineviUible.  The  world  today  is  waking  up  to  several  such  problems.  A  similar  one  is  the  problem  of 
the  social  evil,  and  there  are  many  people  who  say,  with  reference  to  both  of  these  serious  evils,  that 
they  have  always  been,  and  therefore  always  must  be. 

However,  the  most  interesting  thing  in  reference  to  the  midwife  problem  of  the  present  day  is  the 
fact  that  it  is  being  faced,  and  the  paper  which  has  been  presented  to  you  just  now  gives  a  very  ad- 
mirable survey  of  the  questions  that  we  have  to  consider  in  connection  with  it.  In  a  few  communities 
we  have  learned  the  facts  that  warn  us  that  there  are  abroad  in  these  communities  a  body  of  women 
absolutely  untrained  for  the  most  part,  the  majority  of  them  foreigners,  ignorant  of  their  proper  duties, 
who  are  taking  the  responsibility,  and  who  are  permitted  to  take  the  responsibility,  of  caring  for  mother 
and  child  in  confinement.  They  contribute  to  our  statistics  of  infant  mortality  by  reason  of  the  fact 
that  they  are  inadequately  equipped  to  deal  with  the  serious  emergencies  that  from  time  to  time  con- 
front them.  They  are  not  alone,  however,  in  this  contribution,  since  a  study  of  obstetric  statistics  in 
our  cities  emphasizes  the  fact  that  there  are  also  many  improperly  equipped  physicians  who  help  to 
swell  the  mortality  figures. 

The  solution  of  the  midwife  problem  is  important  and  inevitable.  We  must  meet  in  some  way  the 
never-ceasing  call  for  help  from  women  about  to  be  confined.  How  are  we  going  to  meet  it?  Shall 
we  have  one  standard  for  one  woman  and  another  standartl  for  another?  Can  we  differentiate  cases 
and  say  this  is  the  normal  class  and  can  be  cared  for  by  midwives,  and  this  class  is  abnormal  and  re- 
quires more  intelligent  care  than  midwives  can  give?  This  is  not  the  solution,  for  no  human  being  can 
tell  when  a  case  apparently  normal  will  become  pathologic  and  demand  the  utmost  skill.  We  have 
known,  since  the  time  of  Oliver  Wendell  Holmes,  the  nature  of  puerperal  disease,  and  for  many  years 
the  method  of  its  prevention.  The  same  is  true  of  ophthalmia  neonatorum  and  its  prevention,  and  yet 
we  have  never,  up  to  the  present,  applied  this  knowledge  in  such  a  way  as  to  insure  its  benefits  to  al 
women  in  confinement  or  to  the  helpless  new-born  babe. 

I  realize  that  we  are  facing  a  complex  problem.  It  is  not  merely  a  question  of  obstetrics  in  cities; 
that  might  be  comparatively  easy  of  solution,  but  it  is  also  a  question  of  obstetrics  in  rural  communities. 
Take,  for  instance,  such  communities  as  those  in  the  North  Carolina  mountains,  where  the  Holman 
Association  is  doing  its  admirable  work.  We  get  astonishing  facts  from  that  region.  We  are  told  of  a 
mother  who  has  delivered  herself  in  nine  consecutive  pregnancies.  Miss  Holman  told  me  recently  of  a 
man  who  runs  a  saw-mill  in  one  of  these  districts  who  is  sent  for  from  all  the  country  around  because 
he  has  acquired  some  skill  in  the  care  of  women  in  confinement.  Then  we  are  told  of  husbands  who  have 
had  from  one  to  four  wives  who  have  died  one  after  another  in  childbirth  because  of  neglect  in  the  critical 
hour  of  confinement.  What  are  we  going  to  do  in  these  communities  where  they  haven't  even  midwives? 
These  questions  we  cannot  answer  today.  We  must  first  make  a  more  comprehensive  and  sys- 
tematic study  of  the  facts  connected  with  the  whole  problem.  With  this  evidence  before  us,  some 
solution  must  be  forthcoming.  Present  conditions  of  obstetrics  in  the  United  States  are  intolerable. 
I  believe  that  the  problem  we  are  discussing  is  a  woman's  problem,  and  that  we  shall  never  have  a  solu- 
tion of  it  until  women  in  general  learn  of  present  practices  and  demand  better  conditions,  especially  a 
higher  obstetric  standard  for  physicians. 

We  must  offer  to  women  in  confinement  a  care  which  is  commensurate  with  their  needs  and  com- 
mensurate with  our  scientific  knowledge  at  the  present  day;  anything  less  than  this  is  a  sin  upon  our 
souls.     "To  him  that  knoweth  to  do  good  and  doeth  it  not,  to  him  it  is  sin. " 

The  intolerable  conditions  of  midwifery  practice  were  borne  in  upon  me  in  a  very  practical  way, 
not  long  ago,  in  Baltimore,  when  we  tried  to  get  together  a  simple  exhibit  on  midwifery.  Among  other 
things  we  had,  side  by  side,  the  outfit  which  the  average  midwife  in  Baltimore  considers  all  that  she 
needs  to  take  with  her  to  a  case  of  confinement,  and  the  outfit  of  the  obstetric  specialist.  There  was 
the  old,  dirty,  ragged  bag,  with  torn  lining,  and  in  it  were  several  articles  which  I  am  not  going  to  detail — 
a  half  dozen  in  all.  There  was  no  attempt  at  sterilization — nothing  for  a  case  of  emergency;  simply  a 
16 


220       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

few  things  picked  up  from  around  the  house,  stuffed  into  the  bag,  and  taken  to  the  confinement  case. 
Side  by  side  with  this  was  the  equipment  which  Dr.  Williams,  of  the  Hopkins  Hospital,  considered 
necessary  for  the  obstetric  out-patient  service  of  the  hospital.  Here  were  two  large  bags,  filled  with 
most  carefully  prepared  and  sterilized  instruments  and  appliances — an  absolute  contrast  to  the  other. 
That  little  exhibit  taught  a  powerful  lesson,  and  made  me  feel  most  keenly  that  whatever  the  solution 
of  our  problem  may  be,  it  must  be  something  that  will  lessen  the  gap  between  the  absolutely  inade- 
quate and  the  absolutely  essential. 

Dr.  Schereschewsky:  I  merely  want  to  say  a  few  things  in  regard  to  the  condition  of  mid- 
wifery as  it  exists  in  the  United  Stated  today.  This  question  in  our  country  is  entirely  on  a  par  with 
the  conditions  which  existed  when  Meigs  exclaimed,  some  thirty  years  ago,  "The  man  who  tries  to  tell 
me  that  puerperal  fever  is  brought  by  no  other  agency  than  an  act  of  God  is  telling  a  falsehood."  The 
reason  why  some  people  want  to  regulate  the  midwife  and  continue  her  existence  is  because  they  believe 
that  the  foreign  population  demands  the  midwife.  \\'hilc  this  is  true,  it  is  chiefly  so  because  they  have 
been  used  to  the  midwife  at  home.  Every  immigrant  that  comes  to  the  United  States  is  prepared, 
from  the  time  of  his  arrival,  to  detach  himself  from  all  his  previous  conceptions.  He  is  coming  to  a  new 
country,  he  knows  he  is  going  to  be  amongst  a  new  people,  and  he  is  perfectly  ready  to  adopt  what- 
ever seems  to  be  the  standard  practice  of  our  people.  So  that  while  in  Europe  the  immigrant  may  have 
been  used  to  the  midwife,  if  we  have  something  better  to  offer  him  in  this  country  he  will  readily  accept  it. 

There  is  another  thing  to  which  I  wish  to  call  attention  in  connection  with  this  subject,  and  that 
is  that  the  chief  and  most  powerful  means  by  which  we  are  going  to  reduce  infant  mortality  is  the  medical 
supervision  of  the  infants  of  the  poor  during  the  first  year  of  life,  and  yet  in  proposing  to  regulate  the 
midwife  we  are  proceeding  to  deprive  these  infants,  at  the  most  important  moment  of  their  existence,  of 
the  very  medical  protection  that  we  propose  to  give  them  at  a  later  period  of  infancy.  The  reasonable 
conclusion  would  seem  to  be,  therefore,  that  we  should  furnish  a  uniform  standard  of  obstetrics  of  the 
highest  grade,  especially  looking  to  a  proper  medical  supervision  at  birth,  as  well  as  through  the  first 
year  of  life. 

Dr.  Newmayer:  In  Philadelphia  we  have  about  400  practicing  midwives.  Of  these  400,  there 
are  only  about  225  that  we  can  get  hold  of  to  examine  and  license.  The  other  almost  equal  number 
change  their  names  and  places  of  residence  so  frequently  that  it  is  impossible  to  keep  track  of  them.  My 
experience  with  the  midwives  in  Philadelphia,  in  examining  them  for  licensing  and  supervision,  makes 
me  positive  that  midwives  are  a  useless  institution,  but  I  agree  with  Dr.  Huntington  that  it  is  impossible 
to  abolish  the  practice  by  any  law. 

Previous  to  1909  we  had  no  law  in  the  State  of  Pennsylvania  which  gave  us  any  hold  upon  the 
midwife.  In  that  year  a  law  was  enacted  which  gave  us  supervision  over  these  practitioners.  In  June 
of  last  year,  1911,  a  new  act  of  the  legislature  repealed  the  former  law,  and  we  lost  our  supervision  and 
licensing  power.  Through  a  mistake  in  the  act  the  law  became  inoperative  at  the  first  of  the  present 
year.  However,  the  new  medical  board  of  licensure  is  endeavoring  to  formulate  some  method  by  which 
they  hope  to  again  place  the  midwife  under  complete  control  of  the  health  authorities,  and  possibly,  by 
strict  requirements  for  licensing,  enable  us  to  eliminate  a  great  many  of  the  most  worthless,  and  keep  the 
others  under  direct  supervision. 

Dr.  Neff:  The  subject  of  the  next  paper  is  of  deep  interest.  We  have  been 
accustomed  to  speak  of  the  preventable  infant  mortahty  for  a  long  time,  thinking 
that  it  reaches  in  the  neighborhood  of  50  per  cent.,  and  we  have  been  passing  as 
non-preventable  a  large  percentage  of  the  balance,  but  the  steady  progress  made  in 
the  laws  of  eugenics  and  euthenics  within  a  very  short  space  of  time  will,  I  hope, 
lead  us  to  find  that  many  which  we  now  call  non-preventable  deaths  will  be  pre- 
ventable; and  thus  a  large  number  of  people  will  be  saved  for  maturity.  It  gives 
me  pleasure  to  introduce  the  Director  of  Research  in  the  Training  School  for  Back- 
ward and  Feeble-minded  Children  of  Vineland,  N.  J.,  Dr.  Henry  H.  Goddard,  who 
will  speak  on  the  subject,  "The  Control  of  Marriages  of  the  Unfit." 


PROCEEDINGS  OF  COXFEREXCE  ON  INFANT  HYGIENE       221 

THE  CONTROL  OF  MARRIAGES  OF  THE  UNFIT 
BY  HENRY  H.  GODDARD,  Ph.D. 


A  complete  discussion  of  this  toi)ic  would  involve  the  three  subtopics  of  "Who 
are  the  Unfit.''"  "Why  should  they  not  marry?"  "How  can  we  prevent  their 
marrying?" 

Within  the  brief  limits  of  this  paper  it  will  be  possible  merely  to  touch  upon 
these  three  points.  There  are  those  who  would  spend  a  great  deal  of  time  in  dis- 
cussing "Who  shall  decide  as  to  who  are  the  unfit,  and  can  any  one  decide  the 
question?"  We  have,  however,  the  highest  authority  for  the  statement  that  there 
are  persons  concerning  whom  it  may  be  said,  "it  were  better  for  thcni  had  they 
never  been  born."  A  less  humane  civilization  said  it  was  best  that  they  should 
not  live,  and  they  were  accordingly  allowetl  to  die — to  go  to  the  wall  in  the  struggle 
for  existence.  At  present  we  live  by  a  dilfercnt  ethic  and  consider  that  every 
human  life  is  sacred  and  must  be  maintained  by  all  the  arts  at  our  command. 
Therefore  the  only  answer  that  we  can  give  when  we  look  about  us  and  see  people 
who  are  living  in  misery  because  they  are  incapable  of  living  otherwise  is,  "  it  were 
better  if  they  had  never  been  born, "  but  since  they  are  born,  we  must  care  for  them — 
not  only  their  childhood,  but  their  life. 

Who,  then,  are  these  people  who  ought  never  to  have  been  born?  They  are 
those  who  have  inherited  a  degenerate  physique  or  such  low  mentality  that  they 
are  incapable  of  living  a  non-dependent  life  in  the  civilization  in  which  they  are 
placed.  I  do  not  consider  the  group  that  are  supposed  to  have  inherited  a  moral 
nature  that  makes  them  unworthy  of  living,  because  I  doubt  whether  there  is  such 
a  class. 

I  shall  not  take  time  to  argue  the  question  that  those  people  who  have  in- 
herited a  constitution  so  physically  weak  or  degenerate  that  they  are  throughout 
their  lives  not  only  uncomfortable  themselves,  but  also  a  menace  to  their  fellows, 
ought  never  to  have  been  born,  and  that  such  a  strain  in  the  human  stock  should 
be  cut  off  as  soon  as  possible.  Who  these  people  are,  and  what  are  the  physical 
weaknesses  that  are  thus  transmitted,  I  leave  for  the  physicians  to  answer. 

I  am  interested  in  that  other  group,  those  who  have  inlierited  a  mentality  so 
low  that  they  are  "incapable  of  adapting  themselves  to  their  environment"  or  of 
"competing  successfully  with  the  rest  in  the  struggle  for  existence."  Often  physi- 
cally strong  and  robust,  and  with  a  certain  cunning  by  which  they  are  able  partially 
to  make  up  for  their  lack  of  intelligence  and  their  inabihty  to  earn  an  honest  living, 
this  class  of  people  constitutes  the  most  dangerous  element  in  our  community. 
They  make  up  a  large  part  of  our  problem  of  pauperism  and  crime.  They  make 
our  slums  and  help  fill  our  houses  of  prostitution.  They  ought  never  to  have 
been  born,  but  having  been  born,  they  ought  never  to  become  parents  of  more 
people  like  themselves. 


222       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

A  considerable  percentage  of  the  babies  that  we  are  now  trying  to  keep  alive  are 
the  children  of  this  type  of  indiridual.  These  babies  ought  never  to  have  been  born, 
but  having  been  born  and  being  kept  ahve  by  our  charity  and  efforts,  we  should  at 
the  same  time  see  that  they  never  become  parents.  There  are  those  who  maintain 
that  if  these  children  are  kept  alive  and  given  favorable  environment,  and  if  brought 
up  right,  they  become  useful  citizens;  in  other  words,  that  the  whole  problem  is 
one  of  environment.   This  is  one  of  those  one-sided  views  which  is  always  dangerous. 

I  hope  the  time  may  come  when  the  laws  of  heredity  will  be  so  well  understood 
and  the  facts  will  be  so  iridely  known  that  all  will  be  able  to  see  the  bearing  of  these 
laws  upon  our  social  problem.  Today  it  seems  very  difficult  to  teach  the  lesson. 
We  know  that  heredity  is  everything  in  plants  and  animals,  but  we  are  inclined  to 
believe  that  environment  is  everything  when  it  comes  to  man.  But  such  is  not 
the  case.  This  is  being  demonstrated  every  day.  Indeed,  we  have  already  come 
to  the  concept  that  there  are  strains  of  mentaUty  in  the  human  family  that  are 
transmitted  just  as  truly  as  any  other  characteristic.  These  different  strains  have 
different  degrees  of  mental  capacity,  and  range  all  the  way  from  the  imbecile  to  the 
genius,  and  it  is  no  more  possible  to  get  a  genius  out  of  an  imbecile  strain  than  it  is 
to  get  a  red-haired  child  from  a  line  in  which  there  is  nothing  but  black  hair. 

Now,  certain  of  these  strains  are  of  such  low  mental  capacity  that  they  never 
can  adapt  themselves  to  the  environment  found  in  our  modern  civilization.  There- 
fore these  people  are  bound,  as  already  said,  to  be  always  a  burden  to  themselves 
and  a  menace  to  society.  Therefore,  it  were  better  had  they  never  been  born,  but 
being  born,  it  must  be  that  they  shall  never  become  parents.  The  strain  must 
stop  with  them. 

Let  us  see  what  all  this  means  from  a  concrete  illustration,  taken  from  the 
facts  as  far  as  we  know  them.  There  are  in  Philadelphia  today  250,000  children 
in  the  public  schools.  Of  these,  2  per  cent.,  or  5000,  are  feeble-minded.  Of  these, 
again  two-thirds  are  feeble-minded  by  heredity.  That  means  that  when  they  grow 
up  and  marry  they  will  transmit  their  feeble-mindedness  to  their  children. 

All  these  marriages  would  be  unfit;  all  these  marriages  should  be  prevented. 

We  may  now  consider  in  the  briefest  way  the  question  of  how  to  regulate  the 
marriages  of  the  unfit.  I  beUeve  this  needs  to  be  done,  just  as  we  regulate  other 
matters  in  our  social  life,  by  rules  or  laws  and  by  publicity.  For  those  people  who 
have  not  sufficient  intelhgence  to  act  wisely  for  themselves  society  must  act  and 
must  say,  "you  shall  not  marry."  Those  people  who  are  above  this  line  and  have 
intelligence  must  be  educated  to  know  the  fact,  so  they  will  regulate  their  own 
acts  in  accordance  with  knowledge. 

These  are  the  two  lines  along  which  modern  eugenics  is  working.  As  fast  as 
our  heredity  laws  become  discovered  and  understood  they  must  be  made  the  com- 
mon knowledge  of  all  people,  for  surely  no  man  or  woman  would  take  for  a  partner 
in  hfe  a  woman  or  man  whom  he  or  she  had  every  reason  to  expect  would  produce 
children  who  would  be  mentally  defective  and  incapable  of  living  a  normal  life. 

It  is  sometimes  said  that  the  tender  passion  will  never  thus  regulate  itself.  It 
is  true  that  "love  laughs  at  locksmiths,"  but  love  will  not  laugh  at  fate.     That  is 


PROCEEDIXGS  OF  COXFEREXCE  0\  INFANT  HYGIENE       223 

evidenced  today  by  the  thousands  of  young  people  who  refrain  from  matrimony 
not  because  poverty  faces  them,  but  because  of  inabihty  to  live  in  the  lu.rurij  that 
they  want.  The  same  thing  applies  to  the  further  step.  Not  only  will  the  man  or 
woman  refrain  from  taking  a  mate  who  will  beget  or  bear  defective  children  for 
them,  but  the  man  or  woman  who  has  once  become  convinced  that  tlicy  them- 
selves carry  within  them  the  germs  of  defect  or  degeneracy  will  voluntarily  refrain 
from  matrimony. 

The  one  thing  we  need  in  all  this  is  knowledge.  We  need  to  know  the  facts 
and  to  know  the  conditions  under  which  the  facts  apply.  Man  will  gamble  on 
uncertainties,  but  no  man  will  gamble  against  a  sure  thing.  As  long  as  the  laws 
of  transmission  are  not  thoroughly  known,  and  any  man  may  say.  "possibly  I  am 
an  exception,"  so  long  will  many  of  these  marriages  of  the  unfit  take  place.  But 
once  let  the  matter  be  understood  so  that  it  can  be  declared  with  absolute  certainty 
that  such  and  such  consequences  will  follow,  and  men  will  not  take  the  chances, 
except,  as  said  above,  in  those  cases  where  they  have  not  intellect  enough  to  draw 
the  conclusion  from  the  premises.  In  those  cases,  society  nnist  act  for  them  and 
say,  "thou  shaft  not!" 

In  conclusion,  may  I  hope  that  I  have  made  it  clear  that  this  whole  new  move- 
ment along  the  line  of  infant  mortality,  this  baby  saving,  is  fraught  with  tremendous 
consequences  to  the  race,  and  that  unless  we  go  beyond  the  baby  saving,  and  save 
the  adults  from  the  vices  and  evils  to  which  their  very  incapacity  makes  tliem  liable, 
and  save  them  from  becoming  parents,  we  will  in  the  end  be  injuring  the  human 
race,  rather  than  helping  it.  In  all  cases  of  bad  heredity  we  are  saving  these 
babies  to  become  thieves,  paupers,  and  prostitutes,  unless  we  do  something  more 
than  merely  to  keep  them  alive  through  their  infancy  and  childhood.  We  must 
take  care  of  them  through  life. 

I  have  confined  myself  to  the  topic  that  was  assigned  me,  and  have  not  gone 
into  that  large  and  equally  important  question,  so  prominent  among  the  lower 
classes,  where  the  limitation  of  marriage  does  not  limit  the  production  of  offspring. 

Dr.  Neff:  The  discussion  of  this  paper  will  be  opened  by  Dr.  Charles  W. 
Burr,  Professor  of  Mental  Diseases  in  the  University  of  Pennsylvania. 

DISCUSSION  ON  DR.  GODD.\RD'S  PAPER 

Dr.  Charles  W.  Burr,  University  of  Pennsylvania,  Philadelphia:  The  breadth  of  the  subject 
and  the  lateness  of  the  hour  make  it  necessary  for  me  to  present  the  discussion  which  I  have  prepared  in 
abstract;  I  must,  therefore,  ask  you  to  pardon  me  if  I  appear  somewhat  dogmatic  and  dictatorial  in 
what  I  say.  I  have  no  time  to  prove  by  argument  the  statements  that  I  am  about  to  make.  (The  sub- 
joined is  the  original  discussion  and  not  the  abstract.) 

The  real  question  concerns  not  marriage,  but  procreation:  Should  the  unfit,  those  whose  offspring 
are  likely  to  become  public  charges  on  account  of  disease,  the  result  of  their  parentage,  or  to  be  useless 
in  adding  to  the  commonweal — to  be  imbeciles,  insane,  or  criminals  (the  degenerate,  in  a  large  sense) — 
be  permitted  to  procreate  (no  injury  is  done  the  State  by  the  mere  fact  of  marriage,  no  matter  how 
unfit  the  persons  may  be,  if  there  be  no  offspring),  and  if  not,  how  can  they  be  prevented  from  doing  so? 
I  include  criminals,  because  those  who  are  criminal  by  heredity  are  surely  diseased.  This  is  not  synony- 
mous with  saying  that  all  criminals  are  insane,  or  that  all  crime  is  the  result  of  disease.     It  should  Lo 


224        REPORT  OF  THE  PHILADELPHIA  BABY  SAl^NG  SHOW 

remembered  too  that  the  word  criminal  does  not  mean  the  same  thing  to  the  psychologist  and  the  legis- 
lator. Law  judges  a  man  by  his  acts;  psychology  classifies  him  according  to  his  attitude  toward  the 
world,  his  mental  and  moral  point  of  view.  Law  is  interested  in  him  only  in  so  far  as  he  affects  society; 
psychology  is  equally  interested  in  him,  whether  he  influences  society  or  not.  A  man  in  jail,  and  justly 
so,  may  be  less  a  criminal  from  the  psychologic  standpoint  than  another  who  never  broke  the  law. 

I  shall  not  consider  the  question  as  to  whether  life  is  worth  living  to  the  degenerate,  regarding 
himself  alone,  whether,  so  far  as  his  personal  happiness  is  concerned,  it  would  have  been  better  or  worse 
had  he  never  been  born,  but  shall  look  at  the  matter  only  from  the  point  of  view  of  the  welfare  of  the 
commonwealth  and  the  good  of  the  race. 

I  trust  there  is  no  need  for  me  to  explain  that  degeneracy  and  immorality  are  not  synonjTnous; 
that  virtuous  people  may  possess  latent  qualities  which  may,  by  the  molding  influence  of  heredity, 
have  an  evil  effect  upon  the  nature  of  their  offspring.  Though  degeneracy,  in  the  ultimate  analysis, 
is  always  the  result  of  breaking  natural  law,  or,  more  accurately,  is  the  result  of  the  automatic  and  in- 
evitable enforcement  of  natural  law,  the  transgression  is  not  infrequently  unwitting,  innocent,  and  some- 
times unavoidable.  Very  often  the  degenerate  of  certain  types  exercises  great  self-control  in  inhibiting 
throughout  life  the  sexual  instinct  through  fear  of  the  woe  he  might  cause  to  future  generations  by 
marriage.  This  is  true  of  many  epileptics  and  people  in  whose  families  there  is  a  preponderant  strain 
of  insanity. 

That  the  degenerate  should  not  beget  children  is  accepted  in  theory  by  all  students  who  have 
studied  the  matter  clinically,  but,  unfortunately,  there  is  no  unanimity  of  opinion  as  to  whom  we  are 
to  classify  as  degenerates.  My  genius  may  be  your  degenerate.  One  school  holds,  for  example,  that 
all  criminals  are  the  victims  of  environment,  and  that  if  the  good  people  were  not  so  vicious,  if  society 
only  tenderly  cared  for  the  criminal,  there  would  be  no  need  of  jails,  and  some  sociologic  writers,  whose 
personal  acquaintance  with  criminals  is  evidently  nil,  want  to  reverse  all  our  notions  about  morality 
and  have  us  believe  that  the  only  bad  people  in  the  world  are  the  good.  Some  investigators  teach  that 
all  criminals  are  predestined  to  be  such  from  birth,  and  that  we  can  diagnose  them  by  their  physical 
abnormalities.  For  the  purpose  of  this  discussion  I  will  dogmatically  assume  that  the  unfit  are  the 
imbecile,  the  insane,  the  alcoholic  and  other  drug  habitues,  the  so-called  moral  insane,  and  certain 
criminals,  because  these  classes  of  the  community  can  be  controlled  more  or  less,  whereas  if  we  attempt 
too  much  and  endeavor  to  prevent  the  marriage  of  every  one  suffering  from  any  disease,  that,  on  theo- 
retic grounds,  may  cause  abnormal  offspring,  it  will  be  found  that  in  trying  to  do  the  impossible  we  will 
fail  to  accomplish  anything. 

Those  who  maintain  that  heredity  is  nothing  and  environment  everything;  that  any  child  can 
be  made  into  a  mentally  healthy  and  morally  straight  person  if  brought  up  under  proper  influences, 
are  sentimentalists  and  base  their  opinion  on  emotion.  All  children  of  all  degenerates  are  not  degenerate, 
but  the  percentage  is  much  higher  than  in  the  remainder  of  the  population.  The  parents,  or  one  parent, 
of  all  degenerates  are  not  degenerate.  Heredity  is  not  the  sole  cause  of  degeneracy;  indeed,  so  far  is 
this  from  the  truth  that  the  defective  classes  are  being  constantly  recruited  by  the  offspring  of  the  healthy 
so  far  as  we  can  judge  health,  and  let  me  add  that  this  fact  will  greatly  minimize  any  effort  to  improve 
the  race  by  mere  fiat  of  legislation.  Many  factors — disease  in  utero  and  early  childhood,  trauma,  and 
environment  in  the  vulgar  sense — may  have  a  potent  evil  influence.  Pelvic  deformity  in  a  woman 
mentally  and  morally  healthy  may  render  labor  so  difficult  as  to  lead  to  injury  to  the  brain  of  the  child 
of  such  a  nature  as  not  to  produce  death,  but  to  cause  imbecility  and  idiocy.  Acute  illness  of  the  mother 
during  pregnancy  may,  on  theoretic  grounds,  result  disastrously  to  the  brain  development  of  the  fetus 
without  there  being  any  gross  evidence  of  disease.  Syphilis,  which  is  not  in  any  proper  sense  a  heredi- 
tary disease,  but  in  which  the  parent  simply  acts  as  the  carrier  of  the  organism  which  causes  syphilis,  is 
a  frequent  cause  of  imbecility,  and  though  there  are  usually  very  manifest  signs  of  physical  disease  in 
the  infant,  sometimes  the  symptoms  are  purely  mental.  A  surprisingly  large  number  of  children  give 
a  positive  reaction  to  the  Wassermann  and  Noguchi  tests.  I  have  seen  a  few  children  who  have  improved 
very  much  under  specific  treatment,  when  the  only  evidences  of  specific  disease  were  the  positive  re- 
action and  their  ability  to  bear  large  doses  of  antispecifics.  The  influence  of  less  serious  diseases  than 
syphilis  attacking  the  mother  during  pregnancy  is  hard  to  prove,  but  we  are  justified  in  beheving  they 
may  affect  the  child.     This  theory  certainly  explains  some  otherwise  inexplicable  cases. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       225 

It  is  impossible,  in  this  short  time,  to  discuss  the  respective  importance  of  heredity  and  environ- 
ment on  the  character  of  the  individual.  Much  depends  upon  the  definition  of  environment.  If  used 
to  mean  the  general  surroundings,  the  training  and  education,  the  mental  and  emotional  conditions 
under  which  the  child  lives,  then  environment  influences  largely  the  character  and  nature  of  the  very 
large  number  of  children  who  by  heredity  are  so  soft  as  to  be  mere  clay  in  the  hands  of  the  potter;  but 
we  all  see  every  day  many  children  who  go  their  own  way  entirely  uninfluenced  by  their  surroundings — 
we  see  men  of  great  talent  and  noble  character,  whose  environment  wa.s,  during  llie  foriiiati\e  stage  of 
life,  very  poor,  and  degenerates  of  all  kinds  who  wire  trained  most  carefully  in  the  best  surroundings. 
If  it  be  used  to  include  the  influence  of  disease  and  trauma,  then  many  children  whose  heredity  is  normal 
develop  into  defectives  because  of  it.  The  best  heredity  cannot  withstand  a  serious  injury,  cither 
traumatic  or  from  disease,  to  the  brain  in  childhood.  One  would  expect  a  large  number  of  degenerates 
from  malnutrition  in  childhood,  not  from  underfeeding  but  from  disturbances  of  assimilation,  yet  many 
marantic  children  grow  into  mentally  and  morally  normal  men  and  women. 

A  very  important  question  is  the  fitness  of  syphilitics  for  marriage.  Xo  one  should  procreate 
during  the  active  period  of  syphilis  in  any  of  its  stages.  The  more  dilficult  question  to  answer  is,  should 
a  person  who  having  had  syphilis,  has  shown  no  signs  of  it  for  some  years,  and  who  had  undergone 
proper  treatment,  procreate.'  For  practical  purposes  the  answer  should  be  based  not  only  on  the 
possible  injury  to  the  otfspring,  but  on  the  possibility  of  future  illness  in  the  person  himself,  rendering 
him  unable  to  maint.iin  a  household.  I  know  of  no  a<-curate  statistics,  i.  <?.,  dealing  with  large  enough 
numbers,  showing  how  much  the  danger  to  the  offspring  is  increased.  Correct  figures  in  the  matter 
can  not  be  gathered  and  opinions  differ.  I  know  of  many  healthy  children  bom  under  such  conditions, 
but  the  risk  is  surely  great. 

Though  parental  tuberculosis  seems  .slightly  to  increa.se  the  danger  of  insanity  in  the  offspring, 
this  is  offset  by  the  fact — and  it  is  a  fact — that  the  children  of  the  tuberculous  are  very  often  far  aliove 
the  average  in  mental  vigor.  AVhether  the  well-known  mental  brightness  (jf  children  with  tul)er<ulou3 
spine  and  hip  disease  is  due  to  the  fact  that  their  di.sease  makes  them  unable  to  play,  and  hence  forces 
them  to  mental  development,  or  whether  it  is  due  to  the  disease  itself,  is  much  di.scusscd.  I  am  in- 
clined to  think  that  the  nuxlerate  constant,  or  almost  constant,  fever  present  may  act  as  a  stimulant  to 
the  brain,  both  by  its  effect  in  increasing  the  rapidity  of  the  circulation  and  by  its  own  irritant  effect. 

The  most  difficult  degenerates  to  control  are  the  so-called  moral  imbeciles,  because  it  is  almost 
impossible  to  formulate  a  workable  law  concerning  them.  They  are  the  people  who  with  little  or  no 
manifest  mental  weakness  show  no  moral  sense,  seem  deliberately  to  choose  a  life  of  vice  and  crime,  and 
are  entirely  uninfluenced  by  all  efforts  to  reform  them.  Crime  in  the  legal  sense  is  often  only  an  in- 
cident in  their  careers:  vice  is  habitual.  Their  offspring  are  frequently  degenerate.  .Another  class 
very  hard  to  control  are  the  drunkards  and  drug  habitues  in  general.  In  recent  years  the  "cocain 
fiends"  have  become  a  very  serious  problem. 

The  danger  of  producing  defective  offspring  is  not  the  same  in  all  types  of  degenerates.  For- 
tunately one  class,  the  idiots,  are  always  incapable  of  procreation,  and  certain  of  the  insane  lose  both 
sexual  power  and  desire  sooner  or  later.  Among  the  defectives  who  are  able  to  procreate,  the  low- 
grade  imbeciles  almost  never,  if  indeed  ever,  have  normal  children.  The  high-grade  imbecile  may  have 
normal  children,  but  the  chance  is  remote.  It  would  be  interesting  to  know  if  high-grade  imbeciles 
from  accidental  causes  are  as  prone  as  hereditary  imbeciles  to  graft  a  bad  strain  on  a  family.  This 
matter  has  never  been  thoroughly  studied  and  is  rather  of  academic  than  of  practical  importance.  The 
mere  fact  of  insanity,  without  any  qualification,  in  a  parent  does  not  necessarily  lead  to  degeneracy  in 
the  next  generation.  For  example,  because  years  after  the  birth  of  a  child  a  parent  develops  senile 
dementia,  or  has  a  stroke  in  consequence  of  wide-spread  cerebral  arterial  disease,  and  on  account  of  the 
accompanying  sensory  aphasia,  becomes  demented,  it  does  not  mean  that  the  child  will  necessarily 
show  any  sign  of  degeneracy  of  any  kind.  On  the  other  hand,  an  attack  of  apparently  mild  mental 
disease  before,  even  years  before,  the  child's  conception,  increases  the  danger  greatly.  The  actually 
insane  should  under  no  circumstances  procreate.  In  epilepsy  also  the  danger  is  very  great.  Unfor- 
tunately, there  is  a  very  large  class  of  people  who,  though  they  largely  increase  the  number  of  the  de- 
generates, cannot  be  controlled  in  any  way.     I  mean  the  "queer"  people,  the  people  who  have  strange 


226       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

mental  and  moral  traits,  and  who  yet  get  through  life  without  any  breakdown  serious  enough  to  require 
any  medical  attention.     These  and  the  hysterics  make  wretched  parents. 

Another  matter  to  be  remembered  is  that  different  types  of  degeneracy  are  by  heredity  inter- 
changeable; the  epileptic  may  have  insane  children,  the  insane,  hysteric,  the  hysteric,  epileptic. 

Now  as  to  the  remedies.  It  has  been  proposed  to  compel  medical  examination  of  all  candidates 
for  marriage.  This  leaves  out  of  account  the  control  of  the  illegitimate  production  of  children,  a  matter 
of  great  and  increasing  importance.  The  original  idea  was,  I  believe,  to  examine  men  to  discover  the 
presence  or  absence  of  venereal  disease;  today  the  idea  seems  to  be  to  make  a  complete  examination  as 
to  the  physical  and  mental  state  of  both  men  and  women.  Such  thorough  and  complete  examinations 
could  not  be  made  in  practical  life,  and  laws  requiring  them  would  be  but  perfunctorily  enforced.  The 
difficnlties  in  the  way  of  enforcement,  save  in  the  case  of  people  with  marked  visible  disease,  are  insuper- 
able. Persons  who  practice  medicine  according  to  the  tenets  of  peculiar  and  exclusive  schools  would 
sign  certificates  of  health  on  slight  evidence.  So  far  as  the  insane  are  concerned,  they  can  not  even  now, 
if  certified,  marry,  or,  rather,  if  they  do,  the  contract  can  be  made  void.  Parenthetically,  let  me  say 
that  a  surprising  number  of  youths  suffering  from  adolescent  insanity  marry  in  the  very  early  stage,  no 
one  suspecting  they  are  not  in  good  mental  health.  Only  an  alienist,  and  not  always  he,  would  find  any 
illness  in  them.  Not  a  few  such  cases  come  to  every  large  asylum  for  the  insane  a  few  weeks  or  even  a 
few  days  after  marriage.  The  marriages  are  often  annulled,  if  not  by  law,  still  in  fact,  but  too  often 
conception  has  already  occurred.  The  most  dangerous  class  of  the  insane,  from  the  point  of  view  of 
liability  to  procreate,  are  those  whom  no  law  could  include,  the  borderland  cases,  whom  only  alienists 
recognize  and  whom,  if  ^iiey  be  paranoid,  very  often  the  general  public  regard  as  talented  and  brilliant — 
the  general  public,  in  their  intellectual  innocence,  often  mistaking  the  phosphorescence  of  mental  put- 
rescence for  the  clear  light  of  pure  reason.  Alcoholics  should  not  procreate,  but  to  prevent  this  by 
marriage  laws  is  impossible,  except  in  the  most  severe  cases,  even  assuming  such  a  law  would  work  at  all. 
For  very  obvious  reasons  drunken  j^ouths  and  some  not  drunken,  living  in  the  country  and  small  towns, 
are  much  more  likely  to  procreate  indiscriminately  than  youths  living  in  cities.  The  helot  does  not 
conceive. 

The  most  important,  the  most  practical  means  at  our  command  to  reduce  the  number  of  degen- 
erates is  to  take  proper  care  of  imbeciles.  They  should  all  be  segregated  for  life  in  institutions,  preferably 
state  farms.  The  patients  should  have  no  relation  with  the  outside  world.  Education  should  be 
manual  and,  as  far  as  the  imbecile  can  receive  it,  moral,  not  literary.  To  teach  an  imbecile  to  read 
does  not  increase  his  happiness  and  does  increase  his  ability  for  evil.  The  policy  of  sending  an  imbecile 
to  an  institution,  training  him  and  drilling  him,  and  then  turning  him  loose  when  he  reaches  maturity, 
always  leads  to  harm.  Many  a  one  leads  a  happy  life  in  an  institution  and  submits  to  discipUne  easily, 
who  will  go  bad  as  soon  as  he  is  free.  As  a  matter  of  fact,  there  are  several  thousand  at  large  in  Pennsyl- 
vania, and  very  many  procreate.  The  state  of  Pennsylvania,  indeed  the  whole  world,  has  failed  en- 
tirely in  its  duty  toward  them.  If  they  were  all  cared  for  it  would  tremendously  raise  the  mental 
and  moral  level  of  the  state.  It  would  be  economically  wise  because  it  would  decrease  the  number  of 
inmates  of  jails.  Almshouses,  county  jails,  and  houses  of  correction  always  contain  large  numbers 
of  imbeciles  who  lead  therein  a  parasitic  life,  and  often  permanently  hurt  the  youths  there  by  acci- 
dent, whereas  in  properly  managed  institutions,  they  could  be  made  largely  self-supporting. 

Life  imprisonment  of  habitual  criminals  would  be  of  great  service.  Whether  they  be  mentally 
defective  or  not,  they  are  morally  defective,  and  the  State  owes  them  nothing  as  they  are  parasites. 
The  idea  that  they  can  be  made  moral  is  an  idealistic  dream.  An  argument  against  parole  of  prisoners 
is  that  the  clever  plausible  hypocritical  ones,  those  who  are  good  actors,  will  be  those  who  get  parole, 
and  they  will  take  advantage  of  freedom.  Every  prison  warden  knows  that  the  pretty  faced  youth  in 
the  jail  is  not  infrequently  a  much  worse  criminal,  no  matter  how  trivial  the  crime  he  maj'  be  doing 
time  for,  than  the  man  with  the  face  of  a  "plug  ugly,"  but  kind-hearted  prison  visitors  and  those  in- 
terested in  the  "uplift"  of  criminals,  do  not  know  it  and  will  not  believe  it.  There  is  a  prettiness  of 
weakness  which  is  almost  always  associated  with  viciousness. 

The  attitude  of  the  open  door  to  "the  oppressed  of  all  nations"  has  increased  the  number  of  de- 
generates in  this  country.  Some  of  the  "oppressed"  are  vicious,  some  insane,  many  physically  weak. 
Great  efforts  have  been  made  by  sentimentalists  to  nullify  what  laws  we  have  regarding  the  refusal  of 


PROCEEDLXGS  OF  COXFEREXCE  OX  LXFAXT  HYGIENE       227 

admission  of  immigrants  to  this  country  on  medical  prounds.  It  would  be  far  better  for  this  country 
if  some  healthy  immigrants  were  excluded  if  thereby  the  unfit  could  be  kept  out. 

The  above  matters,  i.  e.,  the  segregation  of  in\beciles  and  criminals  and  the  exclusion  of  degenerate 
immigrants,  can  readily  be  controlled  by  law.  Another  proposition,  namely,  surgically  to  asexualize 
certain  persons,  I  do  not  belie\e  would  ever  be  carried  out  on  a  sufficiently  large  scale  to  have  any  ap- 
preciable influence,  though  laws  ordering  it  will  probably  in  the  next  few  years,  during  the  wild  hysteric 
fury  of  social  reform  through  whi<h  we  are  passing,  be  put  on  the  statute  books  of  many  states  and  then 
be  forgotten.     In  a  few  states  laws  concerning  the  matter  arc  already  on  the  statute  book.s. 

The  evil  of  alcoholism  can  best  be  copcfl  with  by  indirect  means.  Prohibition,  api>arcntly,  has 
not  been  a  success;  indeed,  in  some  states  it  seems  to  have  greatly  increased  the  abuse  of  cocain,  e.  g., 
among  the  negroes  of  the  south.  The  gradually,  but  now  rather  rapidly,  increasing  number  of  employ- 
ers of  labor  who  will  not  give  work  to  drinking  men  will  greatly  decrease  the  number  of  drinkers.  Of 
course  the  capitalists  are  not  in  any  way  acting  from  altruistic  motives;  such  a  thotight  is  tcxlay  in- 
conceivable, but  as  often  happens,  their  selfishness  is  wiser  than  some  emotional  altruism.  Fear  of 
losing  a  job  will  not  influence  those  born  to  be  inebriates,  nor  those  who  will  not  work  anyhow,  but  it 
will  keep  from  drinking  many  a  man  who  wants  to  work  but  who  is  susceptible  to  the  influence  of  alcohol. 
The  last  are  worth  saving,  the  others  will  sink  no  matter  what  efforts  are  made  to  keep  them  up. 

Another  way  of  att-icking  the  whole  problem  would  be  to  create  s\ich  a  feeling  of  disgust  for  all 
degeneracy  that  the  normal  boy  or  girl  woulil  not  be  attractcfl  by  the  degenerate,  but  this  would  mean 
a  complete  overturn  of  our  attitude  toward  life  and  would  require  many  generations  to  have  any  effect. 
It  would  mean  going  back  to  the  Greek  ideal — the  worship  of  the  beautiful,  the  strong,  the  sjine,  and 
contempt  for  the  weak.  The  prevalent  attitude  of  the  writers  who  are  supposed  to  mold  public  opinion 
is  the  reverse  of  this.  We  are  continually  having  pity  and  sympathy  preached  at  us.  We  are  even  told 
we  should  breed  with  an  inferior  race,  the  negro,  in  order  to  strengthen  that  race  though  the  evils  of  such 
breeding  are  manifest.  White  children  are  compelled  to  go  to  school  with  negroes,  and  races  that  play 
at  school  will  breed  together  later.  \o  race  was  ever  made  strong  by  pity,  and  it  is  better  to  make  the 
better  best  than  the  worst  only  bad.  Finally,  the  training  of  citizens  in  knowledge  of  physiology,  or 
rather  teaching  them  how  to  live,  would  in  time  exert  a  great  influence  for  good. 

The  arguments  in  this  matter  of  the  control  of  procreation  by  the  unfit  are  not  all  on  one  side. 
There  is  one  against  trying  to  control  procreation  which,  rightly  or  wrongly,  appeals  to  me;  namely, 
that  in  trying  to  eliminate  the  degenerate  we  may  also  eliminate  the  genius  and  without  him  there  would 
be  no  civilization.  Progress  does  not  depend  upon  the  mass  of  men  but  upon  the  few — the  geniuses. 
Strange  as  it  may  seem,  these  biologic  sports  arise  out  of  queer  surroundings  and  sometimes  from  strange 
ancestry.  It  may  be  well  worth  the  world's  while  to  suffer  from  many  degenerates  if  thereby  we  can 
grow  one  genius. 

It  is  said  sometimes  b\'  those  who  oppose  all  attempts  to  control  the  unfit  that  since  they  are  con- 
stantly being  recruited  from  those  of  healthy  ancestry  and  good  surroundings,  it  is  useless  to  try  to  do 
anything.  The  argument  is  scarcely  a  good  one,  because  though  we  cannot  do  a  great  deal,  we  can  do 
something — not  so  much  as  the  enthusiasts  think,  but  yet  something  worth  while. 

Dr.  H.\rt:  I  am  convinced  that  the  last  speaker  is  correct  in  his  belief  that  in  addition  to  proper 
laws  for  the  restriction  of  marriage,  the  entire  segregation  of  the  imbecile  is  necessary.  First  of  all, 
however,  there  should  be  segregation  of  the  feeble-minded  girl  from  twelve  years  old  and  upward.  Here- 
tofore every  State  in  the  Union  which  has  undertaken  the  care  of  the  feeble-minded  has  begun  wrong. 
They  have  established  training-schools  with  the  thought  that,  by  special  forms  of  instruction,  under  the 
guidance  of  specially  equipped  teachers,  and  by  the  application  of  extraordinary  measures  of  one  kind 
and  another,  they  could  develop  the  latent  faculties  of  these  children  and  bring  out  the  qualities  in  them 
that  would  enable  them  to  play  their  part  in  the  activities  of  the  world.  That  has  been  the  universal 
custom  until  within  the  last  year,  and  the  results  have  been  uniformly  disappointing.  .\  few  children 
have  gone  out  from  these  institutions  in  normal  condition,  but  these  are  probably  exclusively  children 
who  were  apparently  feeble-minded,  and  whose  mental  disturbances  were  dependent  upon  some  nutri- 
tional or  other  physical  defect.  Unquestionably,  the  greater  part  of  the  children  sent  out  from  such 
institutions  have  been  returned  after  a  while,  or  have  become  burdensome  to  their  families  or  the  com- 
munities in  which  they  dwell.     It  seems  to  me  that  experience  has  proved   the  ineffectiveness  of  this 


228       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

plan.  These  children  cannot  be  made  normal,  and  as  they  are  a  menace  to  public  morals,  especially  the 
feeble-minded  girl,  I  believe  they  must  become  permanent  wards  of  the  State.  The  last  Legislature 
of  the  State  of  Virginia  passed  an  act  which,  I  believe,  was  inspired  by  me,  and  which  provides  for  the 
care  of  feeble-minded  girls,  and  postpones  provision  for  the  other  feeble-minded  until  the  feeble-minded 
girl  has  been  properly  taken  care  of.  The  State  of  North  Carolina  passed  a  bill  two  years  ago  for  an 
institution  for  feeble-minded,  and  having  been  appealed  to  for  advice  by  the  Board  of  Trustees  of  this 
institution,  I  recommended  that  they  6rst  provide  for  the  feeble-minded  girl.  I  am  informed  that  this 
policy  is  to  be  adopted  in  that  State. 

I  believe  every  State  should  pass  laws  providing  for  the  immediate  care  of  the  girls  of  twelve  years 
of  age  and  upward,  and  not  postpone  legislation  until  such  time  as  they  can  provide  for  the  whole  great 
mass  of  their  feeble-minded.  I  think  this  is  perfectly  practicable.  As  soon  as  possible,  also,  provision 
must  be  made  for  the  feeble-minded  male  imbecile,  but  they  are  much  less  of  a  public  menace.  It  is  a 
well-known  fact  that  while  it  is  very  uncommon  for  a  normal  woman  to  consort  with  a  feeble-minded 
man,  it  is,  alas!  altogether  too  common  for  a  normal  man  to  consort  with  a  feeble-minded  woman. 

Dk.  Godd.\ed:  I  would  just  emphasize  one  thing  Dr.  Hart  has  said.  There  are  still  many  who 
are  of  the  opinion  that  these  feeble-minded  can  be  cured.  I  think  there  is  unanimity  of  belief  among 
all  those  who  have  worked  with  the  feeble-minded,  that  no  feeble-minded  person  was  ever  cured.  It 
was  a  mistaken  diagnosis  to  start  with  if  a  cure  was  effected.  So,  as  Dr.  Hart  says,  we  have  been  on  the 
wrong  side  in  our  methods.  Not  only  are  they  never  cured,  but  among  all  our  children  two-thirds  have 
not  improved  in  mentality  one  iota  in  two  years.  They  have  Improved  in  ability  to  do  a  lot  of  things 
which  required  no  mentality  superior  to  that  which  they  already  possessed,  but  their  mental  powers 
did  not  increase. 

Dr.  Neff:  We  are  gratified  this  evening  to  know  that  we  are  to  have  a  dis- 
cussion of  the  effect  of  housing  conditions  upon  infant  niortahty,  a  subject  which  is 
of  special  importance  to  us  in  Philadelphia,  for  although  we  are  a  city  of  homes,  we 
have  full  knowledge  of  the  bad  factors,  and  some  knowledge  of  how  those  factors 
work.  I  have  great  pleasure  in  presenting  Dr.  Winslow,  Professor  of  Biology  in  the 
College  of  the  City  of  New  York. 


THE  EFFECT  OF  HOUSING  UPON  INFANT  MORTALITY 

BY  PROFESSOR  C.  E.  A.  WINSLOW 

College  of  the  City  of  New  York 


As  you  know,  the  factors  of  infant  mortality  can  be  conveniently  divided  into 
those  which  are  constitutional  and  those  which  are  environmental.  We  have 
just  had  a  striking  demonstration  of  the  importance  of  constitutional  factors.  Of 
the  environmental  factors,  our  attention  has  been  focused  for  the  most  part  on  one, 
to  a  degree  that  I  believe  is  out  of  proportion  to  the  actual  facts.  That,  of  course, 
is  the  milk  supply.  In  all  discussions  of  infant  mortality,  in  all  exhibits  and  con- 
ferences, milk  is  given  first  place  among  the  environmental  factors,  and  probably 
it  should  have  first  place,  but  too  often  it  has  almost  the  sole  place.  Of  course, 
that  is  not  true  in  daily  practice.  The  pediatrist  and  the  infant  mortality  nurse 
have  given  attention  to  the  particular  problem  that  I  am  going  to  discuss  with  you. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       229 

but  in  general  discussions  of  the  subject,  milk  is  the  only  environmental  factor 
considered. 

In  connection  with  the  problem  of  housing  we  have  generally  recognized  among 
the  essential  features,  provision  for  light,  air,  cleanliness,  moral  decency,  and  fire 
protection,  and  all  have  their  bearing  ujion  infant  mortality;  but  the  thing  we  want 
to  focus  our  attention  upon  tonight  is  air  conditioning  and  its  effect  upon  the  infant 
death  rate.  In  the  last  few  years  in  this  country,  we  have  heard  something  about 
this  through  tlie  Germans,  and  we  now  know  what  is  meant  by  air  conditioning. 
We  have  outgrown  the  old  superstitions  which  have  hung  longer  about  litis  par- 
ticular branch  of  sanitary  science  than  about  any  other.  Ten  years  ago,  perhaps, 
most  discussions  on  ventilation  and  air-su])i)Iy  would  have  been  called  "The  Air 
We  Breathe";  and  the  si)eakers  would  have  pointed  out  the  dangers  of  carbon 
dioxide  and  the  dangers  from  morbific  matter,  a  subtle  mysterious  poison  in  the  air 
we  breathe.  Now  we  give  less  consideration  to  the  air  we  breathe  and  more  to  the 
air  which  surrounds  our  bodies.  It  is  not  tiie  carbon  dioxide,  nor  any  chemical 
poison  in  the  air,  l)ut  it  is  the  simple  fact  of  temperature  and  humidity  which  is 
harmful.  It  is  one  of  tlie  curious  instances  of  the  tendency  of  the  human  mind  to 
reach  after  the  far-fetched  and  remote,  that  hygienists  so  long  sought  to  find  some 
mysterious  poison,  and  forget  all  about  temperature  and  humidity. 

We  know,  now,  that  most  of  the  effects  of  bad  air  are  to  be  ex])lained  as  the 
result  of  heat  and  moisture  and  their  unpleasant  effects  on  the  regulating  mechan- 
ism of  the  body.  The  difference  between  bad  air  and  good  air  lies  in  their  effects 
on  the  vasomotor  system. 

The  two  great  preventable  causes  of  infant  mortality,  the  respiratory  diseases 
and  the  diarrheal  diseases,  are  both  very  directly  affected  by  the  housing  factor. 
In  the  publications  of  the  Chicago  Department  of  Health,  cases  of  pneumonia  are 
referred  to  as  "b.ad  air"  diseases.  Some  of  you  may,  perhaps,  remember  Dr. 
Evans'  reference  to  the  "double  cross"  in  Chicago,  showing  the  respiratory  diseases 
in  winter  and  the  diarrheal  diseases  in  summer.  Pneumonia  and  bronchitis,  of 
the  first  class,  make  up  15  to  20  per  cent,  of  the  total  causes  of  mortality  among 
infants.  We  have  no  statistical  evidence  to  show  just  how  great  the  factor  of  bad 
housing  conditions  is,  but  we  do  know  that  pneumonia  and  bronchitis  affect  babies 
and  grown  jjcople  who  are  brought  up  in  overheated  rooms.  There  is  no  doubt 
about  that  general  fact.  Then,  too,  that  other  group  of  diseases,  the  largest  of  all 
the  preventable  groups,  the  diarrheal  diseases,  making  up  from  30  to  40  per  cent, 
of  the  total  infant  death-rate,  can  be  traced  in  large  part  to  this  same  cause;  and 
that  is  a  point  that  some  of  us  have  come  to  realize  only  within  the  last  very  few 
years. 

At  first,  the  summer  diarrhea  of  infants  was  supposed  to  be  due  to  the  direct 
effect  of  heat,  and  then  the  pendulum  swept  the  other  way,  and  it  was  supposed 
that  dirty  milk  alone  was  the  cause.  It  seemed  a  little  curious,  however,  that  milk 
should  be  so  very  much  dirtier  in  summer  than  in  winter.  I  think  Dr.  Neff  will 
bear  me  out  that  even  in  winter  the  milk  supply  of  our  American  cities  has  been 
pretty  dirty  in  the  past.     Dr.  Park  and  Dr.  Holt,  in  1894,  in  New  York,  showed  on 


230       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

a  small  basis  that  babies  fed  on  breast-milk  die  faster  in  summer  than  the  babies 
fed  on  the  worst  grade  of  store  milk  do  in  winter,  from  infant  diarrhea.  So  there 
must  be  another  factor  at  work.  The  German,  Fluegge,  suggested,  in  1879,  that 
heat  itself  was  a  great  cause  of  summer  disease,  and  he  was  followed  up  by  Meinert 
in  1891,  Reitschel,  Liefman  and  Lindemann,  and  others  who  worked  out  monthly 
and  daily  curves,  and  in  the  Rudolf  Virchow  House  in  Berlin  this  question  has 
been  studied  exhaustively.  It  has  been  shown  that  this  is  a  question  of  temperature 
and  humidity,  as  well  as  of  food-supply  among  the  bottle-fed  children.  It  was 
only  when  the  daily  deaths  in  the  most  recent  work  of  Liefmann  and  Lindemann 
were  set  forth  along  with  the  temperature  records  that  the  close  connection  between 
the  two  became  so  clearly  apparent. 

In  the  early  summer  the  babies  die  from  something  very  closely  resembling 
heat  stroke,  and  there  are  sudden  deaths,  ceasing  closely  after  a  drop  in  the  tem- 
perature. They  have  some  very  remarkable  statistics  showing  that  children  in 
cellars  did  not  have  this  early  summer  death-rate,  though  their  milk  was  worse 
than  others.  In  the  late  summer  the  diarrheal  symptoms  are  much  more  evident- 
In  cases  of  heat  stroke  in  early  summer  milk  is,  of  course,  one  important  factor, 
for  children  fed  on  pure  milk  are  able  to  resist  the  heat.  In  the  late  summer,  again, 
diarrheas  affect  the  children  fed  on  bad  milk,  but  it  is  principally  the  combination 
of  bad  milk  and  high  surrounding  temperature  working  together  that  makes  the 
trouble  in  either  case. 

I  do  not  want  any  less  attention  paid  to  the  problem  of  the  milk  supply;  but 
I  think  too  little  weight  has  been  attached  to  the  other  factors.  We  ought  to  have  a 
better  study  of  the  causes  of  the  summer  diarrheas,  and  of  pneumonia,  bronchitis, 
and  the  respiratory  diseases  in  winter. 

Now,  the  connection  with  housing,  of  course,  is  obvious  enough.  Rietschel 
and  some  other  Germans  have  obtained  some  very  striking  data  respecting  the 
excess  of  indoor  temperature  over  outdoor  temperature.  When  the  outdoor 
temperature  reaches  about  73°,  the  death-rate  increases,  and  the  indoor  temperature 
is,  of  course,  worse.  In  one  house  in  Berlin,  two  years  ago,  Rietschel  showed  that 
outdoors  the  maximum  temperature  only  twice  passed  79°,  but  in  the  house  the 
maximum  was  never  below  75°,  and  on  only  three  days  out  of  38  days  was  it  below 
82°.  Twelve  times  it  was  over  86°,  and  three  times  over  97°.  Remember,  this 
was  when  the  temperature  outside  was  under  79°,  except  on  two  occasions.  On 
nine  of  these  days  the  minimum  inside  was  over  77°,  and  on  four  days  it  was  above 
82°. 

Now,  on  this  point  we  have  done  practically  nothing  in  this  country.  Dr. 
Schwartz  in  New  York  has  prepared  some  daily  diagrams,  but  we  have  done  nothing 
to  study  housing  conditions  or  the  temperature  to  which  the  child  is  exposed.  It 
seems  to  me  that  this  work  is  of  importance  enough  for  us  to  turn  our  attention 
to  at  this  time.  There  are  several  things  we  can  do  about  it  practically.  In  the 
first  place  we  need  strong  regulations  for  the  proper  kind  of  housing,  for  better 
tenement  construction,  and  so  on.  In  the  second  place  much  may  be  done  by 
attention  to  the  clothing  and  bathing  of  the  child.     Finally,  it  may  at  times  be 


PROCEEDIXGS  OF  CONFERENCE  ON  INFANT  HYGIENE       231 

possible  to  use  artificially  cooled  rooms  for  therapeutic  purposes.  At  Mt.  Sinai 
Hospital  in  New  York  they  are  planning  to  have  a  cool  room  this  summer  for  the 
treatment  of  infant  cases.  It  is  a  very  curious  tiling  tliat  we  should  warm  our  air 
in  winter,  and  yet  in  summer  we  should  take  the  hot  air  as  a  dispensation  of  Provi- 
dence, for  it  is  just  as  easy  to  cool  the  hot  air  as  it  is  to  warm  the  cold  air,  though  not 
perhaps  just  as  cheap.  Perhaps  in  the  future  we  shall  have  a  more  reasonable 
temperature  in  our  houses,  schools,  and  public  buildings  in  winter,  and  that  we 
shall  use  the  coal  saved  to  cool  them  in  summer.  There  is  a  certain  banking-house 
in  New  York  which  is  kept  cool  in  summer,  and  their  one  comj)laint  is  that  they 
never  can  get  rid  of  anybody  who  once  comes  into  that  office. 

However,  I  am  not  urging  any  specific  measures  so  much  as  I  am  urging  the 
need  for  a  study  of  this  problem,  and  the  necessity  that  it  should  have  an  important 
place  in  our  infant  mortality  program.  I  was  made  Chairman  of  the  Committee 
on  Housing  at  the  last  meeting  of  the  Association  for  the  Prevention  of  Infant 
Mortality,  and  I  should  like  very  much  to  get  practical  workers  interested  in  trying 
to  get  some  data.  I  think  we  ought  in  America  to  be  able  to  make  a  rather  com- 
prehensive study  of  the  effect  of  various  environmental  factors  on  infant  mortality. 
We  could  specialize  at  first  on  diarrhea.  It  is  claimed  in  England,  for  instance, 
that  some  diarrheas  are  contagious,  but  we  do  not  know  anything  about  it.  We 
do  know  that  feeding  is  of  supreme  importance.  We  know  that  temperature  is 
of  great  importance.  Could  we  not  make  a  careful  study  in  some  of  our  large 
cities,  or  in  all  our  large  cities,  of  these  various  sanitary  factors?  Until  we  do,  we 
shall  not  know  definitely  just  what  effect  housing  and  clothing  really  have.  Only  by 
such  a  comprehensive  study  can  we  learn  how  to  rightly  place  our  emphasis  in  the 
campaign  for  the  prevention  of  preventable  infant  mortality. 

Dh.  Neff:  The  discussion  of  this  very  interesting  paper  will  be  opened  by 
the  Secretary  of  the  Philadelphia  Housing  Commission,  Mr.  Bernard  J.  Newman. 

DISCUSSION  ON  PROFESSOR  WINSLOWS  PAPER 

Bern.\rd  J.  Newm.\n:  It  is  almost  useless  to  try  to  add  anything  to  the  discussion  of  so  illuminat- 
ing a  paper  as  this  treatise  on  temperature,  though  I  do  take  exception  to  the  statement  that  the  charac- 
ter of  the  air  has  no  perceptible  influence  upon  the  health  of  the  child.  We  do  know  that  when  we  go 
into  a  house  where  the  windows  and  the  doors  have  been  kept  closed  and  where  there  have  been  from 
four  to  six  people  sleeping,  our  lungs  rebel,  and  we  feel  as  if  we  want  to  gape,  showing  that  our  system 
objects  to  the  kind  of  air  we  are  breathing.  Then  we  also  know  that  air  is  infected  by  environmental 
conditions  that  are  often  a  serious  menace  to  the  health  of  the  infant.  We  know,  for  instance,  that 
wherever  there  is  an  unclean  privy  close  to  the  windows  of  a  home,  the  air  is  infected  and  the  children 
suffer.  We  also  know,  from  reliable  statistics,  that  with  two  people  in  the  room  the  death-rate  averaged 
20  per  1000,  while  with  10  people  in  the  room  the  death-rate  climbed  as  high  as  79  per  1000.  Many  of 
us  know,  also,  the  figures  gathered  in  Berlin,  where  out  of  ^700  children  that  died,  1700  were  bom  and 
lived  in  one-room  apartments,  and  about  947  lived  in  apartments  of  two  rooms,  illustrating  the  direct 
connection  between  the  atmosphere  of  the  room  laden  with  organic  impurities  and  the  health  of  the 
child. 

But  there  is  another  side  that  connects  the  humidity  of  the  air  with  the  health  of  the  child.  We 
know  that  where  there  are  rooms  with  damp  walls,  where  the  cellars  are  filled  with  water,  especially  in  the 


232        REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

summer,  there  is  great  humidity  in  the  air  of  the  house,  and  this  humidity  and  the  air  not  cooHng  off 
over  night  keep  the  temperature  at  fever  heat  and  the  child  suffers.  These  are  all  demonstrated  facts. 
Some  Philadelphia  houses  and  courts  were  found  to  be  from  1G°  to  20°  warmer  than  the  surrounding 
streets. 

One  aspect  of  the  matter  decidedly  interesting  and  worthy  of  investigation  is  the  influence  of  filth 
upon  the  atmosphere.  Out  of  5000  odd  children  that  died  in  Philadelphia  in  1910,  somewhere  between 
22  per  cent,  and  23  per  cent,  died  of  contagious  or  infectious  diseases.  We  know  that  the  danger  from 
these  diseases  comes  through  the  germ,  and  that  the  carriers,  whether  air  or  insects  or  both,  to  the  child, 
are  responsible  for  the  diseases  and  the  subsequent  deaths. 

For  example,  take  again  the  case  of  the  open  privy  vaults.  From  the  vault  it  is  the  8y  that  carries 
the  germ.  Sometimes  a  heap  of  ashes  in  the  yard  covers  the  filth,  and  when  the  ashes  are  disturbed, 
there  is  an  opportunitj'  for  the  germ  to  be  carried  through  the  dust  to  the  child.  AVe  know  of  a  certain 
case  where  there  was  smallpox  in  a  house,  and  after  the  disease  died  out,  and  the  house  was  fumigated, 
a  disturbance  of  rubbish  in  the  yard  caused  a  renewal  of  the  outbreak. 

So  we  could  go  on  giving  instances  of  a  close  relationship  between  bad  ventilation  in  the  dwellings 
and  insanitation  about  them,  and  sickness  and  death  to  the  children.  We  must  bear  in  mind  that  not 
counting  the  20  per  cent,  or  30  per  cent,  of  the  children  born,  who  suffer  in  consequence  of  prenatal 
conditions,  70  per  cent,  suffer  more  or  less  in  consequence  of  conditions  that  exist  in  and  about  the  house. 
Now,  these  conditions  may  not  be  the  primary  cause  of  death,  but  the  disease  itself  is  not  the  primary 
cause.  These  conditions  are  part  of  the  many  causes  that  enter  into  and  affect  the  health  of  infants, 
and  no  matter  how  many  hospitals  we  build,  no  matter  how  many  physicians  are  practicing,  no  matter 
how  many  nurses  are  going  into  the  homes,  unless  we  keep  the  homes  and  their  surroundings  clean,  we 
retain  the  germs  that  are  causing  us  this  problem  of  infant  mortality. 

When  the  French  started  to  build  the  Panama  Canal,  they  sent  over  many  physicians  and  they 
built  hospitals,  but  as  long  as  the  French  were  there  the  hospitals  were  filled.  W  hen  the  United  States 
took  up  construction  work  on  the  Canal  it  sent  down  sanitary  engineers  who  made  drains  and  cleared 
away  the  breeding-places  for  mosquitoes.  Their  hospital  was  never  filled.  Sanitary  improvements 
reduced  the  sickness  and  very  quickly  cut  down  the  death-rate. 

We  may  make  a  temporary  fight  against  diseases  that  cause  infant  mortality,  and  seem  to  be 
winning,  but  unless  we  clear  away  the  contributing  causes  in  insanitation  within  and  about  the  homes 
we  are  not  going  to  enjoy  the  fruits  of  our  apparent  victory  very  long. 

Dr.  Woodward:  I  did  not  come  prepared  to  speak  on  this  particular  subject,  but  it  is  cer- 
tainly very  interesting.  There  are  two  things  which  Professor  Winslow  has  said  which  I  wish  to 
emphasize:  the  first  is  the  importance  of  investigating  the  causes  of  infant  mortality,  and  the  second,  the 
importance  of  not  attributing  so  much  weight  to  the  influence  of  atmospheric  conditions  until  we  know 
more  about  them. 

So  far  as  the  investigation  of  the  cause  of  infant  mortality  is  concerned,  up  to  the  present  time, 
unfortunately,  we  have  to  base  our  conclusions  very  largely  on  the  mortality  figures  alone,  and  not  upon 
the  morbidity  figures  that  are  associated  with  them.  With  infant  mortality,  as  with  mortality  at  all 
other  age  periods,  so  long  as  we  are  limited  to  the  investigation  of  vital  cases,  we  cannot  make  a  thorough 
study  of  the  causes  which  generally  terminate  in  death,  and  we  are  not  going  to  get  satisfactory'  results. 
We  must  remember  that  infant  mortality  is  the  result  of  a  large  number  of  diseases  arising  from  many 
different  causes.  It  is  unnecessary  to  enumerate  them  here,  but  we  know  their  name  is  legion,  that  they 
are  both  constitutional  and  environmental,  and  we  are  not  likely  to  find  all  fatalities,  nor  any  large  pro- 
portion of  them,  directly  associated  with  any  one  factor. 

We  must  not  expect  to  find  a  panacea  for  infant  mortality  or  infant  morbidity.  I  have  listened 
with  much  interest  to  the  suggestion  that  temperature  changes  and  changes  in  the  humidity  of  the 
atmosphere  play  an  important  part  in  the  causation  of  infant  deaths.  It  is  not  clear  to  me  that  we  have 
any  evidence  yet  upon  which  to  base  that  conclusion.  In  the  first  place,  so  far  as  the  infant  is  concerned, 
we  are  dealing  with  a  creature  that  up  to  the  time  of  birth  is  surrounded  by  a  liquid  medium  of  a  tem- 
perature of  practically  98°  F. ;  we  have  to  reckon  with  the  change  that  comes  when  this  child  gets  out 
into  the  atmospheric  air,  with  a  very  much  diminished  water  content.  But  whether  it  is  reasonable  to 
say  that  a  being  which  has  been  developed  in  an  environment  of  98°  and  an  environment  of  absolute 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       233 

saturation  can  stand  this  high  huniiility  and  high  temperature  less  well  than  older  creatures  who  have 
not  been  submitted  to  it,  remains  to  be  proved. 

Then  there  is  another  factor  that  we  will  have  to  reckon  with  in  undertaking  to  determine  the 
effect  of  temperature  and  humidity  on  mortality,  and  that  is  its  relationship  to  breast-feeding.  We 
know  that  breast-fed  infants  do  not  die  in  anything  like  the  proportion  in  hot  weather  that  artificially 
fed  infants  do,  and  if  temperature  and  humidity  are  the  chief  factors,  or  even  very  important  factors, 
why  should  wc  find  such  a  very  marked  ditfercnce?  The  same  thing  is  true  with  respect  to  the  deaths  of 
infants  in  the  country,  for  so  far  as  the  general  temperature  is  concerned,  the  temperature  in  the  country 
is  high  and  the  humidity  also  is  high  at  the  .same  times  that  they  are  high  in  the  neighboring  cities;  and 
yet  wc  know  that  even  in  the  suburbs  of  a  large  city  deaths  are  less  numerous  among  infants  in  the  hot 
weather  than  they  are  in  the  city. 

We  must  suspend  judgment,  I  think.  Wc  must  not  attribute  too  much  weight  to  the  theory  that 
temperature  and  humidity  play  a  very  important  part  in  the  death-rate.  Nevertheless,  the  extent  of 
their  influence  should  be  determined,  while  at  the  3Jime  time  we  study  fully  the  influence  of  the  various 
other  causes,  constitutional  and  environmentjd,  that  lead  to  our  undue  infant  death-rate. 

Dr.  Newmayer:  This  novel  and  interesting  suggestion  of  Dr.  Winslow's  appeals  to  me  suf- 
ficiently to  stimulate  me  to  conduct  a  .series  of  experiments  along  this  line  in  Philadelphia  during  the 
coming  summer.  There  is  no  doubt  that  temperature  and  humidity  not  only  have  their  direct  effect 
upon  the  child,  but  also  upon  the  food  that  i.s  given  to  the  child.  I  presume  this  is  the  reason  why  the 
bottle-fed  babies  have  a  higher  mortality  than  tho.se  fed  at  the  breast.  One  of  the  best  things  in  our 
summer  campaign  in  IMiiladclphia  is  our  recreation  piers.  .\t  one  of  these  piers  wc  cared  for  several 
thousand  children  during  the  summer  months,  with  a  very  low  de.ith-Rite.  I  have  attributed  nmch 
of  this  good  result  to  the  separation  of  these  children  from  their  environment  in  the  very  congested 
tenement  and  slum  districts,  as  well  as  to  the  instruction  of  the  mothers  and  the  good  care  given  the 
infants  by  the  nurses.  I  suppose  I  should  have  added  that  the  lower  temperature  and  fresher  air  that 
were  given  them  for  the  greater  part  of  the  day  and  evening  at  the  piers,  had  at  least  an  equal  effect  upon 
the  lovvering  of  the  mortality.  At  the  same  time  they  were  given  pure  milk,  and  the  mothers  were  taught 
how  to  care  for  and  prepare  this  milk  properly  in  the  home.  I  believe  we  should  provide  more  piers, 
or  more  places  fitted  up  like  piers,  say  in  the  pul)lic  s<|uares,  where  we  might  send  the  children  on  the  hot 
days  of  summer,  thus  separating  them  from  the  hot,  close  and  filthy  quarters  that  they  live  in. 

Mr.  Winslow:  1  did  not  want  to  im])ly  for  a  moment  that  I  do  not  appreciate  the  imi)ortance 
of  sanitary  inspection  and  the  cleaning  up  of  the  nuisances  concerning  which  Mr.  Newman  spoke.  Of 
course,  the  germs  from  the  privy  vaults,  etc.,  cannot  fly  through  the  air,  but  must  be  carried  by  flies  or 
other  insects,  and  anything  that  can  be  done  to  lessen  the  number  of  breeding  and  feeding  grounds  is 
very  important.  One  thing  that  should  be  commented  upon  in  this  connection  is  the  danger  of  infection 
from  the  babies'  diapers.  Very  often  in  houses  where  they  would  be  horrified  at  the  thought  of  main- 
taining anything  insanitary,  the  diapers  are  allowed  to  stand  about  exposed  in  pails  where  flies  can  feed 
upon  and  carry  the  infecting  organisms  which  they  harbor. 

Just  a  word  about  the  statistics  of  housing.  Some  of  these  have  been  very  carefully  collected, 
but  it  is  not  often  done.  When  you  say  that  babies  die  faster  in  a  one-room  tenement  than  in  two  rooms, 
we  must  remember  that  people  live  in  one  room  because  they  are  poor,  and  this  very  likely  will  be  as- 
sociated with  poor  food,  poor  intelligence,  and  other  unfavorable  conditions.  Many  of  them  have  the 
poor  protoplasm  that  Dr.  Goddard  spoke  of.  There  is  a  whole  mass  of  protoplasmic  and  other  con- 
ditions to  be  studied.  Furtliermore,  do  not  let  it  be  thought  that  I  have  minimized  the  importance  of 
good  milk.  There  is  no  doubt  whatever  that  infant  diarrhea  is  caused  in  large  measure  by  bad  milk. 
What  I  want  to  do  is  to  make  a  study  of  all  these  factors,  so  that  not  one  of  them  shall  be  considered 
supreme. 

Dr.  H.wiill;  I  am  sure  you  will  all  agree  with  me  that  this  has  been  a  very  interesting  and  in- 
structive evening,  and  I  know  you  will  gladly  join  with  me  when,  on  behalf  of  the  Executive  Committee 
of  the  liaby  Saving  Show,  I  extend  our  thanks  to  those  who  have  so  ably  participated  in  the  discussion 
of  these  important  problems. 


Third  Session— Thursdmj,  May  23, 10  A.  M. 

Presiding  Officer: 

Mrs.  Owen  Wister,  President  of  the  Civic  Club  of  Philadelphia. 

1.  What  the  Henry  Street  Settlement  is  Doing  to  Conserve  the  Life 

OF  Infants  and  Children: 

Miss  Elizabeth  Farrell,  Resident  of  the  Henry  Street  Settlement,  New- 
York. 

2.  Prenatal  Care: 

Mrs.  William  Lowell  Putnam,  Chairman  of  the  Committee  on  Infant 
Social  Service  of  the  Women's  Municipal  League  of  Boston.  Discussion 
to  be  opened  by  Dr.  Philip  Van  Ingen,  Member  of  New  York  Milk  Com- 
mittee. 

3.  Educational  W'ork  for  Mothers  of  Today  and  Mothers  of  the  Future: 

Dr.  Helen  C.  Putnam,  Director  of  the  American  Association  for  Study 
and  Prevention  of  Infant  Mortality.  Discussion  to  be  opened  by  Mrs. 
Edwin  C.  Grice,  of  Philadelphia. 

4.  The  Value  of  Recreation  in  Relation  to  Infant  Mortality: 

Mrs.  Luther  H.  Gulick,  of  New  York  City.  Di.scussion  to  be  opened  by 
Mr.  Alexander  M.  Wilson,  Assistant  Director  of  the  Department  of  Public 
Health  and  Charities  of  Philadelphia. 


Dr.  S.  McC.  Hamill:  It  gives  me  a  great  pleasure,  indeed,  to  turn  over  the 
direction  of  the  morning's  conference  to  Mrs.  Owen  Wister,  President  of  the  Civic 
Club  of  Philadelphia. 

Mrs.  Owen  Wister:  Philadelphia  is  grateful  to  the  organizers  of  the  Baby 
Saving  Show.  We  are  fully  aware  of  our  indebtedness  to  the  physicians  of  our 
community  who  are  doing  so  much  to  bring  needed  knowledge  to  the  masses  of  our 
great  population.  The  Civic  Club,  which  I  have  the  honor  to  represent,  is  deeply 
interested  in  this  undertaking,  and  is  most  happy  to  be  invited  to  participate  in  it. 

In  the  very  interesting  session  held  in  this  room  yesterday  afternoon  many 
people  were  disappointed  that  they  were  unable  to  listen  to  Dr.  Hastings  H.  Hart, 
of  New  York,  who  could  not  make  the  address  that  was  promised  at  that  time.  We 
are  very  fortunate,  indeed,  in  having  Dr.  Hart  with  us  this  morning,  to  open  the 
third  session  of  this  Conference.  It  is  hardly  necessary  for  me  to  introduce  Dr. 
Hart,  Director  of  the  Department  of  Child  Study  of  the  Russell  Sage  Foundation, 
who  is  so  well  known  not  only  in  this  city,  but  in  all  parts  of  the  United  States. 

234 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  IIYGIF.NK       235 

CARE  OF  INFANTS 
BY  HASTINGS  H.  HART,  LL.D. 

Director,  Department  of  Child-Helping,  Russell  Sage  Foundation 


I  am  asked  to  say  something  about  the  institutional  care  of  infants  and  tlie 
placing  of  infants  in  family  homes.  There  is  often  a  disposition  to  make  a  pro- 
miscuous condemnation  of  institution  care  of  children.  I  am  free  to  admit  that 
my  own  prejudices  are  in  favor  of  family  home  care  of  children.  I  believe  pro- 
foundly in  the  maxim  that  was  laid  do%\-n  by  what  is  known  as  the  White  House 
Conference,  in  1899,  in  Washington,  which  declared  that  "Home  life  is  the  highest 
and  6nest  product  of  civilization — children  should  not  be  deprived  of  it  except  for 
compelling  reasons. " 

I  have  made  a  long  study  of  institutions,  and  the  Russell  Sage  Foundation, 
during  the  past  two  years,  has  made  a  .special  study  of  this  question.  I  am  con- 
vinced that  there  is  a  field  for  a  limited  amount  of  institutional  work  for  infants.  I 
know  from  my  own  observation  that  there  are  institutions  which  are  taking  care 
of  infants  with  at  least  a  reasonable  degree  of  safety  and  success.  For  example, 
there  is  in  the  city  of  Omaha  an  institution  known  as  the  Child  Saving  Institute. 
I  think  that  the  care  of  infants  in  that  institution  approximates  a  proper  standard. 
They  have  a  small  institution — accommodations  at  no  time  for  probably  more  than 
30  infants.  They  have  an  arrangement  with  one  of  the  general  hospitals  whereby 
a  nurse,  after  two  years  of  training  in  the  hospital  training-school,  goes  to  the  Child 
Saving  Institute  for  a  three  months'  special  course  in  the  care  of  infants,  so  that 
all  the  nurses  coming  to  them  have  already  had  two  years  of  actual  class  or  school 
work.  Then  they  have  about  one  nurse  of  this  qualified  character  for  everj'  two 
infants.  They  have  a  head  nurse,  who  is  a  first-class  woman  and  would  stand  well 
in  any  hospital,  for  she  is  well  trained  in  her  science. 

The  handling  of  the  milk  and  the  care  of  the  infants  are  pretty  nearly  ideal. 
I  have  not  the  actual  figures  as  to  the  death-rate  there,  but  I  think  it  is  lower  than 
that  of  infants  in  the  general  population  of  the  city  of  Omaha.  There  is  one  thing 
about  that  place  that  I  think  should  be  considered  more  seriously,  and  that  is 
that  the  dormitories  contain  some  15  beds  for  infants.  I  do  not  think  there  should 
be  that  many  infants  in  one  room. 

You  may  consider  also  an  institution  like  the  Babies'  Ho.spital  of  the  city  of 
New  York,  under  Dr.  L.  Emmett  Holt.  There  also  the  infants  are  cared  for  under 
pretty  nearly  ideal  conditions,  and  if  all  institutions  for  infants  had  a  standard  as 
high  as  this  one,  I  do  not  think  that  any  one  would  want  to  denounce  them.  The 
Babies'  Hospital  in  Newark,  N.  J.,  under  Dr.  Henry  L.  Coit,  is  another  example  of 
a  high-class  institution  for  infants.  The  study  and  records  of  the  individual  child 
from  the  medical  standpoint  are  there  carried  far  above  that  in  any  other  place  with 
which  I  am  acquainted.     Dr.  Coit  has  given  an  infinite  amount  of  study  to  this 


236       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

matter  and  has  produced  results  that  cannot  be  surpassed.  I  do  not  think  he  has 
estabhshed  a  standard  method,  because  it  is  a  little  too  elaborate  for  general  use, 
but  I  believe  that  he  has  marked  out  the  Une  which  must  be  followed  in  a  somewhat 
modified  form  if  we  are  to  care  for  infants  successfully  m  our  large  cities. 

There  are  other  institutions  also  that  are  doing  good  work  in  endeavoring  to 
maintain  high  standards.  On  the  other  hand,  I  think  it  has  to  be  said,  in  all  fair- 
ness, that  the  progress  made  in  the  last  two  years  in  the  reduction  of  infant  mor- 
tality has  not  been  shared  in  adequately  by  the  large  institutions  for  uifants.  It 
seems  to  be  the  general  belief  that  the  institutions  have  not  kept  up  with  the  work 
of  the  health  boards  and  the  milk  committees  in  the  reduction  of  infant  niortahty. 
They  cannot  do  it  with  their  present  equipment,  with  their  present  force  of  nurses 
and  other  help,  and  with  the  other  machinery  which  they  have  thus  far  applied. 

There  is  another  line  of  institutional  care  for  infants  that  is  to  be  considered, 
and  that  is  the  institutions  which  receive  mothers  and  infants  together,  requiring 
the  mother  to  nurse  the  child,  and  in  some  instances  to  divide  her  milk  between  her 
own  child  and  a  foundling  baby.  There  is  a  large  number  of  institutions  of  this 
type.  The  Chicago  Foundlings'  Home  is  a  good  illustration.  They  have  handled 
this  problem  for  many  years,  and  have  had  a  rule  that  they  would  not  receive  a 
baby  if  the  mother  was  known  unless  the  mother  came  with  it.  They  were  re- 
quired after  coming  to  divide  their  milk,  and  they  were  given  the  care  of  physicians 
and  nurses,  the  child  supplementing  mother's  milk  with  cow's  milk,  and  they  have 
had  very  satisfactory  results. 

There  are  84  Florence  Crittenden  homes  throughout  the  country,  and  al- 
though there  have  been  great  differences  in  the  quality  of  work  they  performed  in 
the  different  cities,  many  of  them  are  standing  firmly  for  the  breast  nursing  of  the 
child  and  u.se  every  influence  to  have  the  mother  nurse  her  child,  at  least  until  the 
child  is  through  the  nursing  period  and  has  acquired  the  teeth  necessary  to  permit 
it  to  take  different  food. 

There  are  also  many  institutions  of  the  same  kind  maintained  by  Catholic 
sisterhoods  and  by  different  corporations.  In  my  judgment  it  is  very  imwise  to 
condemn  the  work  of  these  institutions  as  long  as  they  will  adliere  firmly  to  the 
plan  of  the  mother  nursing  her  own  child.  Of  course,  there  is  also  the  whole 
question  of  the  future  of  the  child  and  what  disposition  should  be  made  of  it,  but 
I  am  speaking  at  the  present  time  only  of  the  question  of  infant  mortalitj'  as  af- 
fected by  the  institutional  care  of  the  infant. 

It  is  difficult  to  get  a  just  view  of  the  work  of  the  institutions,  because  there 
are  no  adequate  statistics  on  the  question.  None  of  the  statistics  now  available 
as  to  this  phase  of  infant  mortaUty  can  be  regarded  as  wholly  reliable.  The  sta- 
tistics published  in  New  York  cover  infants  up  to  two  years.  We  have  no  infant 
mortality  statistics  covering  those  under  one  year  old.  They  are  also  compUcated 
by  the  fact  of  the  different  ages  at  which  the  infants  are  received  at  these  institu- 
tions. 

I  visited  an  institution  the  other  day  which  seemed  ideal,  but  the  minimum  of 
age  at  which  these  children  were  received  was  three  months,  and,  of  course,  we  do 


PROCEEDLXGS  OF  COXFEREXCE  ON  LXFAXT  HYGIENE       237 

not  know  what  happened  to  those  that  didn't  come  in  under  the  three  months. 
Naturally,  the  mortality  rate  in  that  institution  was  low.  I  wish  we  had  better 
statistics  on  these  questions.  The  facts  exist,  and  the  figures  are  recorded  in  our 
cities,  but  somehow  we  cannot  get  at  them. 

As  to  the  matter  of  placing  the  child  in  the  family  home,  that  term  means 
different  things  in  different  parts  of  the  countrj'  and  in  different  cities.  In  the 
West  and  in  Chicago,  when  they  speak  of  placing  a  child  in  a  home,  they  almost 
always  mean  giving  it  out  to  what  we  call  a  free  home,  where  the  child  is  received 
by  the  people,  cared  for  at  their  own  expense,  made  a  member  of  the  family,  and, 
in  a  large  proportion  of  the  cases,  is  taken  for  legal  adoption.  That  is  one  propo- 
sition. In  this  city  and  in  Boston,  and  in  Massachusetts  generally,  when  they 
speak  of  placing  out  an  infant  they  usually  mean  placing  the  child  in  a  family  on 
board,  where  the  board  is  i)aid  cither  in  whole  or  in  part  by  the  parents,  or  perhaps 
by  some  private  organization,  or  by  the  city  or  State.  Now  these  different  methods 
of  placing  the  child  mean  different  things. 

You  will  find  again  that  it  is  extremely  difficult  to  get  reliable  statistics  on  the 
mortality  question  with  reference  to  babies  that  are  boarded  out.  It  makes  a  dif- 
ference whether  the  baby  is  boarded  out  immediately  after  birth  or  within  two  or 
three  days  afterward,  or  not  until  the  age  of  three  or  four  months.  In  the  last 
case  you  have  left  out  of  account  those  that  died  in  the  mean  time. 

The  placing  of  children  in  family  homes  may  be  done  in  any  one  of  several 
different  ways.  In  Massachusetts  they  believe  and  advocate  very  strenuously 
the  idea  that  institutional  care  of  infants  is  entirely  uimecessary.  In  New  York 
they  believe  that  it  is  necessary  to  have  some  place  where  the  large  number  of 
foundling  infants  and  the  large  number  of  mothers  with  illegitimate  children  can 
be  received,  sifted,  and  distributed  to  the  proper  points.  The  Bellevue  Hospital 
performs  that  function  for  a  large  part  of  New  York.  In  Boston  the  children's 
societies  have  arranged  so  that  if  a  child  is  brought  Ln  at  4  o'clock  in  the  afternoon, 
the  child  is  received,  has  a  medical  examination,  and  before  5  o'clock  is  sent  out 
to  a  family  home.  The  board  is  paid  by  the  society.  The  boarding-out  method 
has  been  practised  extensively  by  the  State  Board  of  Charity  of  Massachusetts 
since  the  year  1868.  Prior  to  that  time  babies  were  sent  to  the  State  almshouse. 
Babies  are  boarded  out  by  the  city  of  Boston,  and,  to  a  limited  extent,  by  four 
different  societies  in  the  city  of  Boston.  The  method  has  been  practised  also  by 
the  State  Charities  Aid  Association  in  the  city  of  New  York,  and  by  the  Children's 
Aid  Society  in  Philadelphia. 

The  rate  paid  for  board  is  very  moderate — too  moderate.  It  used  to  be  as 
low  as  $2,  with  $2.50  as  the  maximum.  Now  the  rate  runs  from  $2.50  to  $3.50, 
and,  in  some  cases,  to  $4  a  week,  for  babies  boarded  out  by  these  public  and  private 
institutions.  When  you  pay  a  woman  $2.50  for  the  care  of  a  baby  and  she  has  to 
purchase  her  own  milk,  has  to  sit  up  at  night  with  the  child,  and  has  to  take  all  the 
responsibihty  and  anxiety  of  the  child,  you  may  imagine  that  the  compensation 
is  exceedingly  meager.  If  she  has  a  sick  child  which  will  keep  her  up  at  night,  the 
maximum  of  $3.50  a  week  would  certainly  not  be  called  extravagant  compensation. 


238       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

I  think  that  the  women  who  undertake  this  work  of  nursing  children  are  to  a 
large  extent  actuated  by  altruistic  motives,  and  the  best  institutions  take  that 
motive  into  account.  The  increase  in  the  family  expense  by  the  purchase  and 
care  of  milk  is  considerable.  I  do  not  think  the  payment  for  board  ought  to  be 
less  than  $3  a  week,  and  those  societies  that  are  interested  in  that  work  ought  to 
get  it  up  to  that  standard. 

I  am  told  by  people  who  are  engaged  in  this  work- — and  I  have  had  some  ex- 
perience myself  in  Chicago — that  it  is  not  at  all  impossible  to  get  reliable  boarding- 
houses  for  babies.  The  great  question  in  the  past  has  been  the  lack  of  sufficient 
strictness  in  selection.  Advertisements  are  inserted  in  the  newspapers  and  appli- 
cants come  in  because  the  organization  is  known  to  have  money  for  the  care  of 
babies,  and  in  some  instances  babies  are  boarded  out  without  opportunity  for  proper 
inspection.  The  number  of  available  homes  can  be  greatly  increased  by  a  careful 
search,  wider  advertising,  and  by  making  use  of  certain  private  agencies. 

There  is  no  question  that  homes  ought  to  be  selected  with  the  utmost  care. 
When  the  home  is  brought  to  the  attention  of  the  agency,  an  experienced,  capable, 
discriminating  agent  should  go  out  at  once  and  make  an  examination  of  the  home, 
its  environment,  its  sanitary  conditions,  its  arrangements  for  ventilation  and  heat- 
ing, the  care  of  the  family,  and  so  on.  You  will  want  to  know  whether  there  is 
any  tuberculosis  in  the  family  or  any  other  infectious  disease,  and  you  will  want 
to  know  what  have  been  the  reputation  and  standing  of  the  people  in  the  community 
in  order  to  get  a  proper  selection.  This  is  not  obtained  by  any  deductive  method. 
It  must  be  obtained  by  an  agent  who  has  acquired  by  experience  such  discernment 
as  will  enable  her  to  discover  the  essential  things  in  that  home,  by  going  into  it 
and  making  observations  directly  and  personally  instead  of  by  going  around  to 
neighbors.  The  investigation  of  homes  can  be  overdone.  We  have  several  in- 
stitutions in  New  York  that  place  out  children,  and  the  selection  of  homes  is  done 
in  this  way:  first,  the  applicant  comes  to  the  organization.  The  latter  sends  its 
agent,  who  goes  into  the  home.  If  they  find  conditions  satisfactory,  notice  is  sent 
at  once  to  the  health  department.  An  inspector  of  the  health  department  also 
makes  an  inspection  before  the  child  is  placed.  The  place  is  also  open  to  the  in- 
spection of  at  least  three  agencies  who  will  go  through  the  same  procedure,  and 
some  caretakers  have  complained  that  they  could  not  take  proper  care  of  the  babies 
because  they  had  so  many  inspections.  I  think  that  one  efficient  inspector  could 
do  better  work  than  these  five,  ■n'ith  less  mconvenience  to  the  foster  mother. 

Another  line  of  investigation  concerns  the  placing  of  children  in  family  homes 
for  adoption.  Many  of  our  institutions  make  it  a  habit  to  keep  these  babies,  if 
they  survive,  until  they  are  two  to  three  years  old,  before  placing  them  in  a  family 
home.  I  have  been  entirely  unable  to  understand  the  psychology  of  that  method. 
It  is  expensive.  It  is  hard  on  the  child,  who  keeps  possession  of  quarters  that 
might  be  given  up  to  another,  and  I  could  never  miderstand  if  a  child  is  to  be  placed 
in  a  family  home,  why  it  should  not  go  there  as  an  infant.  It  is  easier  to  find  a 
satisfactory  home  for  an  infant  than  for  an  older  child.  He  is  much  more  able  to 
adapt  himseK  to  the  ways  of  the  home  and  become  a  permanent  member  of  the 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       239 

family  and  become  assimilated  by  the  family.  There  should  be  an  early  de- 
termination of  the  question  whether  the  child  is  to  be  placed  in  a  home,  and  if  so, 
the  earUer  the  better.  It  is  far  better  for  them  to  be  in  well-selected  family  homes. 
You  can  place  them  in  homes  and  still  give  them  the  same  care  and  advantage  of 
medical  attention  which  they  would  get  in  the  institution. 

There  is  a  third  method  of  caring  for  children  by  placing  them  in  family  homes 
that  is  extensively  practised  in  New  York  city  and  Philadelphia  and  other  cities 
to  a  limited  extent.  This  is  the  method  of  boarding  out  children  with  wet-nurses 
in  their  own  homes.  I  have  been  astonished  to  find  to  what  an  extent  this  is 
possible.  The  New  York  Foundling  Hospital  has  in  the  neighborhood  of  300 
infants  boarded  out  with  wet-nurse  mothers.  These  are  usually  women  who  have 
had  miscarriages.  The  method  of  finding  these  women  in  New  York  is  usually 
by  personal  acquaintance  among  the  women.  A  large  majority  of  these  are  Italian 
mothers.  In  some  cities  these  mothers  have  been  found  by  watching  the  health 
department  records.  In  any  city  where  you  have  a  prompt  report  of  births  it  s 
possible  to  trace  the  cases  of  premature  birth  in  this  way,  and  where  the  child  has 
been  lost  at  birth  the  mother  is  promptly  hunted  up  and  the  effort  made  to  induce 
her  to  receive  a  child  for  wet-nursing. 

It  is  not  necessary  to  exercise  the  same  degree  of  care  in  selectmg  the  homes 
of  these  wet-nurses  as  in  the  cases  of  bottle-fed  babies.  As  a  matter  of  fact,  it  is 
safe  sometimes  to  put  a  child  on  the  breast  in  a  home  where  you  would  not  trust 
a  bottle-fed  baby.  Of  course,  it  is  desirable  that  the  conditions  should  be  sanitary 
and  the  woman  cleanly,  but  if  you  have  a  healthy  woman  and  a  home  that  is  reason- 
ably sanitary,  a  child  may  be  kept  there  sue  or  eight  months  on  the  breast  with 
comparatively  little  danger  if  there  is  proper  medical  and  nursing  supervision.  It 
has  been  demonstrated  in  New  York  and  in  Philadelphia  that  a  very  nmch  larger 
number  of  such  nursing  women  can  be  found  than  is  supposed.  I  have  been  sur- 
prised that  in  some  other  cities  the  work  has  been  abandoned  because  it  was  claimed 
that  the  mothers  could  not  be  found.  These  nurses  can  be  found  by  proper  methods 
of  search. 

The  compensation  paid  is  ridiculously  small.  In  New  York,  for  more  than 
thirty  years,  the  standard  pay  has  been  $10  a  month  for  a  woman  who  receives  a 
child  in  her  ovm  home  and  gives  it  nursing  at  the  breast.  That  compensation 
is  certainly  inadequate  and  ought  to  be  increased,  and  it  is  one  of  the  obstacles 
which  prevents  finding  a  sufficient  number  of  mothers.  The  institutions  that 
have  been  doing  this  work  have  been  reluctant  to  increase  the  compensation  be- 
cause they  never  have  enough  money  to  do  all  they  would  like  to  do.  At  the  same 
time  they  have  been  forced  in  a  considerable  number  of  cases  to  put  babies  on  the 
bottle  that  might  have  been  put  on  the  breast.  When  the  child  received  is  sick 
and  gives  the  mother  special  care,  anxiety,  and  responsibility,  it  would  seem  entirely 
reasonable  to  give  them  from  $2  to  $5  a  month  as  extra  compensation. 

If  you  will  read  the  reports  of  St.  Vincent's  Home,  you  will  get  an  idea  of  what 
has  been  accompUshed  in  Philadelphia.     They  began  ten  or  eleven  years  ago  on 


240       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

this  nursing  proposition.  Prior  to  that  time  their  mortahty  rate  had  been  extreme, 
and  their  reports  show  that  they  immediately  succeeded  in  reducing  it. 

When  infants  are  boarded  out,  either  with  wet-nurses  or  on  the  bottle,  it  is 
extremely  important  that  there  should  be  an  adequate  supervision.  Many  of 
the  agencies  that  have  used  these  methods  have  been  delinquent  in  this  respect. 
As  I  have  indicated,  where  babies  are  bottle  fed  the  homes  should  be  selected  with 
special  care  as  to  the  interior  conditions  and  environment.  The  women  in  all 
cases  should  be  carefully  instructed  as  to  feeding  and  should  receive  instructions 
from  the  nurse  and  physician,  and  should  be  visited  by  the  nurse  at  frequent  inter- 
vals. 

The  most  thorough  work  in  this  respect  that  I  know  is  done  at  Morristown, 
N.  J.,  under  the  Speedwell  Society,  organized  by  Dr.  Chapin,  of  New  York.  They 
have  an  abundance  of  fresh  air;  the  babies  are  visited  at  least  as  often  as  once  in 
two  days,  and  every  day  if  they  need  medical  attention,  and  they  are  kept  under 
very  close  medical  and  nurse  supervision.  Most  of  the  babies  received  there 
suffer  from  marasmic  conditions  from  which  they  would  ine\'itably  die  under 
ordinary  conditions,  and  a  very  large  proportion  of  them  are  saved. 

It  is  absolutely  essential  that  we  should  have  an  adequate  visiting  nurse  service 
and  medical  service  at  command.  Many  of  the  institutions  require  that  a  baby 
reported  sick  should  be  brought  to  the  institution.  This  sometimes  means  a 
journey  of  five  to  ten  miles  in  a  wagon  or  car  with  the  temperature  perhaps  90° 
in  the  shade  or  20°  below  zero.  Then  it  is  found  that  the  child  requires  medical 
care,  and  it  is  taken  from  its  mother's  breast  and  placed  in  the  hospital  at  the  very 
time  it  needs  breast  nursing.  Medical  ser\'ice  should  be  available  in  the  home. 
The  visiting  nurse  should  be  on  call  on  the  telephone  and  should  have  the  power 
to  call  the  physician  if  necessary  without  the  formality  of  sending  the  child  to  the 
institution.  I  am  convinced  that  a  very  large  proportion  of  the  work  now  done  in 
institutions  could  be  much  more  profitably  done  outside  of  the  institutions.  There 
is  a  large  expense  attached  to  keeping  adequate  nursing  force.  I  think  one  nurse 
for  two  babies  is  not  too  many.  When  you  come  to  take  into  consideration  the 
housing  and  feeding  of  the  nurses,  their  discipline  and  training,  you  run  into  a  very 
large  amount  of  expense.  I  believe,  therefore,  it  would  be  wise  for  every  society 
to  study  carefully  the  method  of  placing  children  in  family  homes. 

Mrs.  Wister:  The  formal  discussion  of  the  subject  of  Dr.  Hart's  paper  was 
made  a  part  of  the  program  of  the  first  session  of  this  Conference.  We  shall, 
therefore,  proceed  with  the  regular  program  of  the  morning. 

The  next  subject  to  be  discussed  is,  "What  the  Henry  Street  Settlement  is 
Doing  to  Conserve  the  Life  of  Infants  and  Children."  Modern  society  owes  a 
very  great  debt  to  the  College  Settlement.  It  has  pointed  out  a  new  aspect  of 
human  brotherhood  which  is  taught  by  example  more  easily  than  by  precept.  A 
city  must  live  with  an  open  mind.  It  must  look  about  and  learn  and  take  the  best 
it  can  get  from  such  observation.  I,  for  one,  have  always  been  extremely  glad  that 
the  great  neighboring  and  cosmopolitan  city  of  New  York  lies  within  the  radius 


PROCEEDINGS  OF  COXFERENCE  ON  INFANT  HYGIENE       241 

of  our  vision.  There  are  many  things  that  we  have  learned  from  New  York,  many 
more  that  we  are  all  glad  to  learn,  and  I  know  that  we  have  an  extremely  warm 
welcome  this  morning  for  Miss  Elizabeth  Farrell,  Resident  of  the  Henry  Street 
Settlement  of  New  York  city,  whom  it  gives  me  great  pleasure  to  present  to  you. 


THE  HENRY  STREET  SETTLEMENT'S  CONTRIBUTION 

TOWARD  THE  CONSERVATION  OF  INFANT 

HEALTH  AND  LIFE 

BY  ELIZABETH  E.  FARRELL 


For  the  sake  of  tiiosc  who  do  not  know  the  neighborhood  in  which  the  Henry 
Street  Settlement  works,  permit  me  to  say  that,  while  it  is  located  and  its  main 
field  is  in  tlie  lower  East  Side  of  New  York,  where  the  congestion  is  said  to  be  as 
great  as  in  any  other  part  of  the  globe,  it  is  not  limited  to  this  locality.  It  reaches 
all  parts  of  the  city  through  its  various  activities.  There  are  numerous  branch 
bouses — one  in  the  Bohemian  colony:  one  in  the  colored  section,  etc.  This  sug- 
gests the  conception  of  its  duty  to  the  city,  and  is  suggestive  of  the  social  problems 
that  the  Settlement  attempts  to  solve. 

This  ideal  and  the  variety  of  problems  presented  necessitate  well-organized 
and  highly  specialized  work.  I  shall  deal  only  with  that  phase  of  the  work  which 
affects  infant  and  child  life,  and  discuss  first,  as  perhaps  the  most  interesting  feature, 
the  work  of  the  milk  station.  It  should  be  borne  in  mind  that  conditions  here  are 
nearly  ideal.  A  limited  milk  supply  permits  of  approximately  complete  control 
with  regard  to  number  of  babies,  their  cure,  etc.  It  is  quite  impossible,  at  present, 
at  least,  for  municipal  milk  stations  to  provide  anything  like  the  quality  of  milk 
provided  for  babies  by  the  Settlement  milk  station.  The  milk  dispensed  there  is 
furnished  by  a  friend  of  babies,  a  man  of  large  means,  who  makes  available  almost 
the  entire  product  of  his  dairy.  Only  the  small  amount  of  milk  which  is  needed 
for  the  use  of  his  immediate  family  is  kept  out.  The  dairy  is  as  sanitary  and  up- 
to-date  as  science  can  make  it.  The  herd  is  made  up  of  the  finest  line  of  stock,  and 
the  plant  and  its  equipment  are  frequently  inspected.  A  graduate  of  an  agricul- 
tural college  is  in  charge.  Everything  is  done  to  maintain  the  highest  standard. 
Another  important,  indeed  almost  unique,  feature  of  the  milk  station  is  that  the 
milk  dispensed  each  day  represents  the  product  of  that  morning's  milking.  Through 
the  generosity  of  an  express  company  a  wagon  awaits  the  train  and  brings  the  milk 
directly  to  the  milk  station,  where  it  is  bottled  for  distribution  to  the  mothers  whose 
babies  are  under  the  care  of  the  Settlement.  The  milk  is  not  pasteurized.  The 
bacterial  count  is  uniformly  low.  It  has  been  as  low  as  600  to  the  cubic  centimeter. 
The  highest  grade  milk  sold  in  New  York  city  contains  30,000  bacteria  to  the  cubic 
centimeter.     The   County   Medical  Society   certifies  this   milk.     There  are   two 


242       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

articles  of  faith  which  Miss  Wald  beheves  essential  in  milk  station  work.  First: 
milk  for  babies  should  be  modified  only  in  accordance  with  their  individual  needs; 
second,  the  education  of  the  mother  is  fundamental. 

In  order  that  the  milk  may  be  properly  modified  it  is  required  that  the  baby 
be  brought  to  see  the  clinic  doctor,  who  examines  him,  weighs  him,  talks  with  the 
mother,  and  then  gives  a  formula  for  the  modified  milk.  This  formula  is  given 
to  the  nurse.  Does  this  not  seem  reasonable?  We  would  not  think  of  giving 
the  same  amount  of  medicine  to  whole  groups  of  children  who  come  to  a  clinic, 
and  yet  many  of  us  think  the  same  modification  of  milk  is  good  for  all  children. 
Our  contention  is  that  the  milk  must  be  modified  to  suit  the  individual,  and  that 
point  must  never  be  lost  sight  of  by  the  doctor  or  by  the  nurse. 

The  formula  is  taken  by  the  nurse  to  the  home.  At  her  first  visit  she  explains 
the  formula  to  the  mother,  does  all  the  work  of  modification  herself,  thus  making 
the  lesson  practical  and  concrete.  The  nurse  herself  sterilizes  the  bottles  and  the 
nipples  that  go  on  the  bottles.  She  puts  the  required  amount  of  barley  and  sugar 
in  the  milk.  This  is  done  with  the  mother  looking  on  and  helping  as  required. 
When  the  milk  is  prepared,  it  is  bottled  and  put  on  ice.  Enough  milk  is  modified 
to  last  until  the  visit  of  the  nurse  the  following  day.  At  this  second  visit  the 
mother  modifies  the  milk  under  the  supervision  of  the  nurse.  If  she  has  not  yet 
learned  the  lesson,  the  nurse  gives  her  further  instruction.  In  this  work  the  nurse 
uses  the  utensils  she  finds  in  the  home.  She  uses  the  family  spoons,  cups,  and 
basins,  and  does  not  take  things  into  the  house.  Because  of  the  nurse's  visit  the 
mother  has  learned  what  is  meant  by  modification,  and  how  it  is  accomplished, 
and  the  nurse  has  learned  what  utensils  are  lacking  for  the  proper  preparation  of 
the  milk  and  what  means  the  mother  has  for  their  sterilization.  In  addition,  she 
frequently  finds  conditions  which  oppress  the  family  and  which  they  alone,  be- 
cause of  ignorance  or  prejudice,  cannot  remove.  The  mother  brings  the  baby  back 
to  the  clinic  once  a  week  while  she  is  getting  Settlement  milk.  If  she  does  not 
return,  the  nurse  looks  her  up.  If  she  persists  in  not  bringing  the  child  for  the 
doctor's  help,  she  is  dropped  from  the  milk  station  records.  This,  however,  almost 
never  occurs.  At  each  return  visit  the  baby  is  weighed  and  examined  by  the  physi- 
cian. The  mother  becomes  interested  in  the  procedure,  and  is  exceedingly  anxious 
to  see  a  gain  from  week  to  week.  Breast-feeding,  of  course,  is  encouraged  to  the 
utmost.  The  babies  are  kept  at  the  breast  as  long  as  they  thrive.  If  the  mother's 
milk  supply  is  insufficient,  she  is  urged  to  continue  the  breast  and  is  allowed  to  get 
milk  to  drink  in  order  that  she  may  be  better  able  to  nurse  the  baby.  If  necessary, 
the  physician  orders  that  the  baby  be  given  the  bottle  to  supplement  the  breast- 
feeding. Mothers  finding  that  the  baby  gains  on  this  mixed  feeding  sometimes 
want  to  discontinue  the  breast.  If  they,  by  chance,  do  discontinue  the  breast 
for  a  few  days  and  find  that  the  baby  has  not  gained  satisfactorily,  they  are  easily 
persuaded  to  return  to  the  nursing. 

In  connection  with  the  supply  of  good  milk  for  the  babies  the  Settlement 
gymnasium  is  open  to  the  mothers  and  babies  during  the  hot  weather.  Hammocks 
and  cots  are  provided  for  the  children ;  there  is  a  nurse  in  attendance,  and  mUk  and 


PROCEEDIMGS  OF  COyPERENCE  OX  IXFAXT  HYGIENE       243 

baths  are  given.  Mothers  and  babies  often  come  in  the  morning  and  sit  throughout 
the  day,  where  they  are  out  of  the  heat  and  away  from  the  congestion  and  noise 
of  the  streets  and  of  the  tenement  houses.  This  single  privilege  alone  is  a  great 
baby  saver.  For  a  limited  number  of  worn-out  mothers  with  sick  babies  the  farm 
offers  a  refuge  for  an  indefinite  period  in  summer.  Here  they  are  under  medical 
care  and  are  given  the  best  possible  food,  and  have  all  the  advantages  of  outdoor 
life.  In  addition,  the  recreation  piers,  floating  hospitals,  fresh-air  and  convalescent 
homes,  and  similar  agencies,  either  pulilic  or  {)rivate,  are  used  to  their  capacity. 
By  building  up  the  health  of  these  mothers  the  health  of  the  babies  is  insured.  Last 
summer,  during  the  hot  spell,  there  were  under  Settlement  care  200  babies.  Of 
this  number,  not  one  was  lost. 

In  addition  to  the  milk  station  work  the  Settlement  looks  after  babies  and 
children  in  all  conditions  of  ill  health.  Last  year  no  less  than  3000  cases  of  pneu- 
monia were  cared  for.  The  percentage  of  cures,  approximately  91  per  cent.,  com- 
pared with  that  of  hospitals  (pediatrists  report  35  per  cent,  mortality  from  hos- 
pitals) for  similar  work,  is  most  commendable.  In  hospitals  babies  often  suffer 
from  cross  infection,  and,  in  addition,  little  babies  taken  to  the  hospitals  often  i)ine 
for  their  mothers  and  die,  just  as  they  do  in  the  foundling  a.sylums,  from  lack  of 
mothering.  By  keeping  them  in  their  homes  and  giving  them  the  mother's  care 
and  love  they  do  get  well.  Again,  the  advantage  of  this  method  of  handling  sick 
children  is  that  the  mother  is  taught  the  importance  of  individual  and  proper  care 
of  her  children.  The  education  of  the  mother  and  of  the  family  is  carried  on  while 
the  sick  child  is  being  nursed  back  to  health.  The  nurse  who  visits  the  home  from 
day  to  day  teaches  the  mother  how  to  give  her  sick  child  an  alcohol  bath,  how  to 
put  on  a  compress,  etc.  As  the  child  improves  under  the  fresh-air  treatment  the 
mother  learns  the  value  of  open  windows  and  sunlight.  The  Settlement  .seeks  by 
education  to  "modify"  the  mother  and  to  make  her  influence  felt  in  the  family  and 
in  the  neighborhood  in  which  she  lives.  To  this  end  the  Mothers'  Club  was  or- 
ganized. The  mothers  are  women  who  are  knowm  through  the  milk  station  or 
through  the  district  nursing  service.  At  its  last  meeting  there  were  150  mothers 
present,  a  remarkable  showing  in  busy  New  York,  in  crowded  districts  where 
mothers  are  supposed  to  be  ignorant  and  not  intelligently  interested  in  their  own 
or  their  children's  welfare.  Not  only  does  the  Settlement  go  to  the  mother,  but 
it  brings  the  mother  to  the  Settlement. 

The  Settlement  has  also  in  its  district  nursing  service  a  staff  for  the  investiga- 
tion and  care  of  cases  of  contagious  diseases.  If,  for  instance,  one  of  the  milk 
station  nurses  hears  of  the  existence  of  a  case  of  contagious  disease,  the  fact  is 
immediately  reported  to  the  Settlement,  and  a  nurse  from  the  contagion  staff  is 
sent  to  the  house  at  once.  There  is,  too,  a  staff  of  nurses  to  look  after  confinement 
cases  alone.  The  recent  campaigns  for  the  regulation  of  midwifery,  prevention  of 
blindness,  the  control  of  tuberculosis,  the  instruction  in  hygiene,  as  well  as  that 
for  playgrounds,  found  strong  support  and  intelligent  guidance  in  the  Settlement. 

This  work  for  babies  and  children  has  grown  into  what  is  now  the  most  im- 
portant recent  thing  in  public  education,  the  establishment  in  the  public-school 


244       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

system  of  a  regular  corps  of  school  nurses.  This  movement,  now  so  general,  is 
due  entirely  to  the  influence  of  the  Henry  Street  Settlement.  \Mien  the  Com- 
pulsory School  Attendance  Law  went  into  effect,  it  sent  all  the  children  into  the 
school;  then  followed  the  medical  inspection  of  school-children,  which  has  worked 
for  the  common  good  by  eliminating  the  physically  unfit  from  the  schools.  Into 
this  field  came  the  school  nurse,  and  she  has  demonstrated  that  many  children 
whom  medical  inspectors  were  compelled  to  exclude  from  the  schools  can  be  kept 
there  without  detriment  to  themselves  or  to  the  other  children  if  proper  treatment 
is  provided.  This  treatment  the  nurse  gives.  The  educational  value  of  this  work 
is  again  the  dominant  note.  The  school  nurse,  by  going  into  the  home,  educates 
the  mother  in  personal  hygiene,  in  the  care  of  clothing,  the  cleansing  of  hands, 
heads,  teeth,  and  bodies  of  her  children.  This  all  contributes  to  the  lessening  of 
contagion  in  the  schools,  which,  of  course,  was  the  original  purpose  of  medical  in- 
spection of  school-children;  at  the  same  time  it  makes  the  mother  more  intelligent 
on  those  problems  which  arise  because  of  the  crowded  conditions  of  city  life. 

In  a  very  general  way  this  is  the  story  of  what  the  Settlement  is  doing  to  con- 
serve the  health  and  the  life  of  infants  and  children.  We  can  scarcely  hope,  at 
this  time,  to  furnish  all  children  in  a  given  municipality  with  the  service  now  avail- 
able for  a  few  children  under  the  care  of  the  Settlement.  It  is  the  function  of  the 
Settlement,  as  of  all  volunteer  agencies,  to  experiment,  to  point  the  way,  to  present 
an  ideal  of  accomplishment  that  can  be  realized.  This  experiment  demonstrates 
that  it  is  possible  to  solve  the  problem  of  infant  mortality,  and  suggests  that  infant 
mortality  is  but  an  index  of  social  conditions;  it  points  out  that  infant  mortality 
is  in  direct  proportion  to  the  ignorance  of  the  mother  and  the  economic  status  of 
the  family.  The  ideal  it  presents  is  one  of  method.  Not  the  alleviation  of  in- 
dividual cases,  however  great  in  number  they  may  be,  but  the  ideal  to  be  realized 
is  the  prevention  of  infant  mortality  by  means  of  the  education  of  the  mother  in 
the  home. 

Mrs.  Wister:  We  are  fortunate  in  having  heard  the  civic  appeal  in  the 
closing  remarks  of  Miss  Farrell,  and  I  am  sure  that  every  one  of  you  has  been  inter- 
ested in  the  wonderful  record  of  those  200  infants.  The  rest  of  the  story  of  the 
200  babies  will  also  be  very  interesting,  and  I  hope  that  we  may  get  it  some  time 
in  the  future.  I  also  welcome  very  much  the  expression,  "modifying  the  mother." 
I  think  it  a  very  illuminating  phrase,  and  one  very  illuminating  to  the  people 
carrying  on  this  work.  No  one  has  been  appointed  to  open  the  discussion  of  Miss 
Farrell's  paper,  but  I  am  sure  we  would  be  glad  to  have  a  discussion  of  it. 

Mrs.  Putnam:  I  should  like  to  know  the  ages  of  the  200  babies. 

Miss  Farrell:  I  am  sorry  that  I  did  not  bring  these  statistics  along  with  me.  The  babies,  how- 
ever, were  all  very  young,  the  youngest  probably  about  seven  weeks,  and  the  oldest  probably  not  more 
than  eleven  months. 

Mrs.  Wister:  Yesterday  afternoon  I  think  all  of  us  must  have  been  impressed 
by  the  infant  mortahty  statistics  presented  at  the  Conference,  which  indicated  the 
large  number  of  very  young  babies  dying  each  year.     We  all  knew,  perhaps,  that 


PROCEEDINGS  OF  COXFERENCE  OX  IXFAXT  TIYGIEXE       245 

the  poor  little  babies  die,  but  I  imagine  that  many  of  us  did  not  realize  the  large 
proportion  that  die  in  the  first  day,  week  or  month  of  life.  In  Boston  a  great  work 
has  been  carried  on  to  mitigate  and  prevent  this  very  early  mortality.  In  the  past 
winter  two  very  interesting  addresses  were  given  in  Philadelphia  by  Miss  Bowker, 
President  of  the  Women's  Municipal  League  of  Boston,  and  among  other  phases 
of  the  work  undertaken  by  that  great  League  is  the  work  for  the  prenatal  care  of 
infants.  It  was  new  to  many  of  us,  and  was  listened  to  with  the  deepest  interest. 
Today  we  are  to  learn  more  of  this  same  remarkable  work  from  a  member  of  the 
same  society,  and  a  leader  on  the  Committee  for  the  Prenatal  ("are  of  Infants. 
We  know  it  will  be  of  the  deepest  interest  to  every  one  connected  with  this  Baby 
Saving  Show  to  listen  to  a  description  of  this  work.  I  have  great  pleasure  in  intro- 
ducing I\Irs.  William  Lowell  Putnam,  Chairman  of  the  Committee  on  Infant  Social 
Service  of  the  Women's  Municipal  League  of  Boston. 


PRENATAL  CARE  OF  INFANTS 
BY  INIKS.  WILLIAM  LOWELL  PUTNAM 


I  once  heard  a  lady  inveigh  against  the  telephone  because  she  said  it  did  away 
■with  all  forethought,  and  her  idea  of  forethought  was  that  we  must  today  plan  for 
tomorrow's  dinner.  It  is  perhaps  unnecessary  to  add  that  she  had  no  children 
unexpectedly  to  fill  the  house  with  guests — her  life  was  not  so  ordered  that  she 
could  ajijireciate  the  blessed  modern  appliances  wliich  make  us  able  to  obey  the 
Scriptural  injunction  to  let  the  morrow  take  thought  for  the  tilings  of  itself.  Fore- 
thought cannot  be  done  away  ■nith;  the  ditfercnce  between  us  and  the  earlier 
generation  is  in  the  kind  of  forethought  we  use.  We  are  saved  from  much  drudgery 
which  was  needful  for  them,  and  thereby  are  we  made  free  to  prepare  for  the  future 
in  ways  of  which  they  did  not  dream. 

What  better  kind  of  forethought  can  we  use  than  that  shown  in  preventive 
medicine.'  We  are  moving  toward  the  greatest  step,  slowly,  with  hesitancy,  and 
against  opposition,  but  the  world  is  gaining  the  strength  to  take  it — that  step  is 
the  prevention  of  the  reproduction  of  unfitness.  But  even  if  we  are  not  yet  ready 
to  take  this  step,  there  is  another,  second  only  to  it,  which  sounds  the  keynote  of 
prevention  in  the  life  of  the  individual,  and  that  is  prenatal  care.  It  is  of  this 
work,  as  carried  on  by  a  committee  of  the  Women's  Municipal  League  of  Boston, 
that  I  want  to  tell  you  something. 

Three  years  ago  last  month  we  started  an  experiment  with  pregnant  women, 
to  see  what  benefit,  if  any,  would  result  from  the  careful  watching  of  these  patients 
by  a  nurse  under  the  orders  of  a  physician.  We  did  not  want  to  take  them  from 
their  homes  and  put  them  into  rest  houses,  for  pregnancy  is  a  normal  function,  and 
pregnant  women  should  be  surrounded,  in  so  far  as  it  is  possible,  by  normal  sur- 


246       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Foundings — we  wanted  only  to  help  them  to  make  their  homes  as  ideal  as  they 
could  be  made,  and  all  the  influences  which  could  affect  their  babies,  both  physical 
and  s])iritual,  as  nearly  perfect  as  it  was  possible  to  make  them.  The  character, 
therefore,  of  the  nurses  doing  this  work  is  even  more  important  than  that  of  other 
nurses,  for  a  woman  is  peculiarly  susceptible  to  influence  when  she  is  carrying  a 
child.  Of  this  spiritual  side  of  this  work  I  want  to  speak  again  later,  but  first  we 
must  take  up  the  physical  side,  for  without  our  bodies  we  can  ill  harbor  souls. 

Our  patients  are  ordinary  women  surrounded  by  ordinary  circumstances — 
part  of  them  belong  to  the  self-respecting  poor,  but  some  are  socially  above  and 
some  below  this  level. 

Every  patient  is  visited  as  a  matter  of  routine  at  least  once  in  ten  days,  and 
we  believe  that,  if  possible,  once  a  week  would  be  better.  If  any  untoward  cir- 
cumstances develop,  the  patient  is  visited  as  much  oftener  as  is  necessary.  The 
nurse  advises  the  patient  with  regard  to  exercise,  diet,  and  clothing;  she  recommends 
fresh  air,  plenty  of  water,  inside  and  outside,  rest,  recreation,  and  work  of  the  right 
kind,  but  she  never  advises  anything  (except  with  the  doctor's  orders)  more  drastic 
than  cascara  for  internal  benefit,  or  the  strapping  of  an  aching  back  for  external 
relief.  At  every  visit  she  takes  the  blood-pressure  with  a  little  Tycos  machine 
which  she  carries  with  her,  and  she  also  tests  the  urine  as  a  matter  of  course,  for 
we  are  determined  to  see  if  it  is  not  possible  to  forestall  the  development  of  eclampsia 
through  the  thorough  investigation  of  these  two  matters.  The  result  of  the  care 
has  been  very  gratifying  with  regard  to  the  reduction  in  the  number  of  cases  where 
this  disease  has  threatened.  During  our  first  year  the  percentage  of  cases  which 
showed  symptoms  of  threatened  eclampsia  was  10.2  per  cent.,  which  is  not  far  from 
an  average  number.  During  the  second  year  the  percentage  of  these  cases  dropped 
to  4.8  per  cent.,  and  this  year  it  has  been  but  1.7  per  cent. — this  with  a  constantly 
increasing  number  of  pregnant  women  under  our  care. 

With  but  one  nurse  we  are  able  to  keep  from  80  to  100  names  on  our  list  all 
the  time,  and  though  many  of  them  move  away  and  are  thus  taken  out  of  our  care, 
we  have  carried  safely  to  confinement  1111  women.  No  patient  has  died  during 
pregnancy  in  the  whole  three  years.  In  the  first  year  there  were  two  miscarriages, 
only  one  in  the  second,  and  none  at  all  last  year.  The  percentage  of  still  births 
in  1911  was  1.9  per  cent.,  of  premature  births,  2.1  per  cent. 

Counting  even  the  premature  infants,  the  birth-weight  of  our  babies  is  very 
considerably  above  the  average,  and  yet  not  suflBciently  so  to  make  it  hard  for  the 
mother.  It  varies  from  8  to  15  ounces  above  the  general  average  of  7  pounds,  as 
given  by  Dr.  Whitridge  Williams.  This  year  it  has  reached  the  higher  figure. 
We  feel  that  these  15  ounces  must  give  the  baby  a  little  more  to  draw  on  during 
that  trying  period  of  adjustment  to  the  new  surroundings  confronting  it  at  birth, 
which,  though  we  have  all  forgotten  it,  I  fancy  must  be  a  difficult  feat  at  best. 

The  cost  of  the  work  is  only  $2.50  to  $3.00  per  patient  for  the  full  time  visited, 
which  has  averaged  between  two  and  three  months,  although  sometimes  we  have 
them  come  to  us  as  early  in  their  pregnancy  as  possible.  We  encourage  the  women 
to  pay  the  expense  of  their  care,  or  as  much  of  it  as  they  are  able,  for  we  believe 


PROCEEDINGS  OF  CONFEREXCE  ON  INFANT  HYGIENE       247 

that  it  promotes  their  own  self-respect  to  do  so,  and  that  it  is  much  better  for  the 
work  that  it  be  made  self-supporting  as  soon  as  possililc,  for  in  this  way  its  de- 
velopment can  be  unlimited.  It  is  well  to  try  experiments  with  money  raised 
for  the  purpose,  but  when  a  work  has  proved  itself  of  value,  charitable  support 
for  it  should  cease  as  soon  as  it  can  stand  alone. 

The  patients  are  so  grateful  for  the  help  given  them.  One  woman,  at  the 
nurse's  first  visit,  gave  her  a  pass-key  that  she  might  come  in  more  easily,  and  the 
second  time  she  called  her  patient  had  a  dollar  ready  for  her.  Though,  of  course, 
like  every  one  else,  the  nur.se  meets  with  an  occasional  rebuff,  .she  is  much  more 
often  greeted  with  remarks  like  this:  "Nur.se.  it  means  so  much  to  have  yon  come." 
or,  "Nurse,  after  your  visit  I  feel  so  much  better,"  and  she  finds  her.sclf  able  to 
allay  many  groundless  fears.  Some  patients  say:  "Every  one  is  .so  ready  to  give 
you  advice  when  they  see  your  condition,  but  I  just  .said  to  my  husband,  T  will 
wait  and  ask  nurse  when  .she  comes,'"  and  then  it  apiiears  that  the  advice  gi\en 
by  her  neighbor  was  not  to  take  a  bath,  but  to  drink  beer  to  keep  up  her  strength 
and  to  promote  the  flow  of  milk,  perhaps  six  months  subsequently,  or  if  not  lliis, 
then  some  equally  sapient  suggestion.  Among  the  younger  coui)les,  particularly, 
she  hears:  "My  husband  thinks  this  work  is  fine,  iiaving  a  nurse  call" — and  the 
husband  often  suggests  to  his  wife  questions  to  ask  the  nurse.  Occa.sionally  she 
has  made  to  her  the  amusing  announcement  that  the  husband  has  changed  his  diet 
to  that  recommended  to  the  wife,  and  thinks  his  health  distinctly  benefitted  by  the 
change.  One  woman  .sent  ])artieulariy  for  the  imrse  to  come  to  .see  her  baby  be- 
cause she  said  she  felt  as  if  our  mirse  had  a  part  in  him — with  her  first  baby  she 
had  had  a  very  hard  time,  but  with  this  one  everything  had  gone  all  right.  It  is  not 
only  among  the  women  in  their  first  pregnancy  that  the  work  is  appreciated.  One 
patient  whom  we  cared  for  while  she  was  carrying  her  sixth  baby  wrote  afterward 
that  slie  had  done  everything  our  nurse  had  told  her  and  had  never  had  such  an 
easy  time  before,  and  that  it  was  so  pleasant  to  have  some  one  take  care  of  her. 

What  I  mean  by  the  possibilities  of  the  spiritual  side  of  prenatal  care  is  best 
shown  by  the  story  of  Miss  Strong's  Httle  prenatal  Easter  party.  Miss  Strong  is 
a  member  of  our  committee,  and  is  herself  a  trained  nurse  resident  at  South  End 
House.  She  has  a  group  of  women  among  her  neighbors  to  whom  she  gives  the 
best  kind  of  prenatal  care,  because  it  fills  the  spiritual  need  as  well  as  the  ])hysical. 
She  has  stamp  savings  books  ornamented  with  charming  baby  heads,  and  pasted 
all  over  the  back  with  lambs  and  flowers,  each  little  device  chosen  by  the  mother 
as  her  heart  longs  for  it.  On  Easter  morning,  at  7  o'clock.  Miss  Strong  had  her 
Easter  party.  The  breakfast  table  was  set  with  dainty  little  yellow  and  white 
blossoms,  budding  horse-chestnuts  opened  their  little  hands  in  a  tall  vase  beside 
them,  little  white  chickens  and  bunnies  gamboled  over  the  table-cloth,  and  at  each 
place  was  one  white  crocus  in  a  little  pot,  and  a  tiny  white  candle  which  to  those 
women  typified  the  light  of  the  little  life  to  come  forth.  Everything  was  perfect 
except  Mrs.  McCarthy,  who  had  had  something  to  drink  stronger  than  her  early 
cup  of  tea.  This  caused  Mrs.  ISIcCarthj'  to  be  full  of  the  spirit  so  often  shown, 
alas !  in  all  ranks  of  life,  which  spirit  she  gave  vent  to  in  such  remarks  as  that  she 


248       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

wasn't  "going  to  get  caught  this  way  again, "  etc.,  remarks  -mth  which  we  are  all  too 
familiar,  and  which  were  quickly  marring  the  spirit  of  the  httle  Easter  party.  As 
they  sat  down  to  breakfast  Miss  Strong,  with  disappointment  gnawing  at  her 
heart-strings,  had  an  inspiration;  she  turned  to  Mrs.  McCarthy  and  asked  her 
to  say  grace.  Such  a  thing  had  never  been  asked  before,  and  Mrs.  McCarthy's 
soul  was  melted  within  her.  She  could  not  say  any  grace,  but  neither  could  she 
jeer  with  the  thought  of  grace  in  her  heart.  The  difficulty  was  arranged  by  Miss 
Strong's  suggesting  that  they  should  each  say  grace  for  themselves,  and  the  spirit 
of  Easter  brooded  once  more  o^'er  the  12  women  there  gathered. 

With  us  the  work  is  spreading  most  encouragingly.  Within  the  year  the 
Boston  Lying-in  Hospital  has  established  a  prenatal  clinic  with  a  visiting  nurse, 
and  since  last  summer  our  Board  of  Health  has  been  sending  out  two  nurses  through- 
out the  city  to  care  for  mothers  and  babies  as  well  as  after  birth.  Boston  is  trying 
to  establish  a  standard  for  this  work  among  all  its  workers,  and  for  this  object  a 
permanent  committee  was  apiwinted  at  a  meeting  held  last  ]March,  at  which  were 
present  representatives  of  all  organizations  giving  prenatal  care.  We  want  not 
only  to  estabhsh  a  standard,  but  to  coordinate  this  work.  It  is  hoped  that  through 
the  Instructive  District  Nursing  Association  this  can  be  accomplished,  and  we  are 
now  giving  half  of  our  nurse's  time  to  helping  the  association  to  standardize  this 
work,  and  by  their  request  are  supervising  all  of  their  prenatal  work. 

One  great  benefit  to  be  derived  from  prenatal  care  is  the  education  of  the 
prospective  mother  not  only  in  the  proper  way  to  care  for  her  coming  baby  after 
it  arrives,  but  also  at  the  time  of  its  arrival.  Prenatal  care  should  do  much  to 
undermine  the  prestige  of  the  ignorant  practitioner  and  the  midwife,  and  to  sub- 
stitute for  them  proper  medical  obstetric  care,  the  benefits  of  which  to  the  present 
and  future  generations  would  be  untold. 

We  are  looking  forward  to  the  time  when  prenatal  care  shall  become  as  much 
an  accompaniment  of  pregnancy  as  is  care  at  a  child's  birth.  This  care  should  be 
given  patients  by  a  nurse  working  under  a  physician,  for  $5  or  $6  a  patient,  for 
the  full  term  of  pregnancy.  Thus  the  best  possible  care  would  be  assured  to  those 
women  who  cannot  afford  doctors'  visits  except  in  case  of  illness,  and  even  among 
the  rich  it  would  be  desirable.  It  is  unnecessary  and  wasteful  for  a  doctor  to  give 
his  time  to  visiting  a  patient  who  is  perfectly  well  in  order  to  see  that  this  condition 
of  health  continues,  when  this  object  can  be  accomi)lished  equally  well  and  at 
greatly  reduced  cost  through  the  employment  of  a  trained  nurse.  In  fact,  this 
is  the  only  way  that  those  of  moderate  means  can  have  prenatal  care.  The  bene- 
fits of  the  arrangement  would  be  threefold :  First,  it  would  insure  better  care  to  the 
patient,  as  through  the  nurse's  knowledge  a  doctor  would  be  summoned  in  cases 
where  the  patient  herself  is  often  too  ignorant  of  the  danger  of  her  condition  to 
summon  him;  Second,  it  would  increase  the  doctor's  practice  for  the  same  reason; 
third,  it  would  support  the  nurse.  The  plan  of  having  a  nurse  supplement  the 
doctor  by  keeping  him  in  constant  touch  with  all  his  patients,  yet  calhng  him  in 
only  when  he  is  really  needed,  is  the  efficient  and  business-hke  way  of  caring  for 
them,  and  one  which  must  in  time  commend  itself  to  the  community. 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       249 

Mrs.  Wister:  I  know  how  deeply  interested  the  members  of  this  Conference 
have  been  in  hearing  about  this  work.  It  should  now  be  helpful  to  listen  to  a 
further  discussion  of  this  subject,  and  I  have  [)loasiire  in  presenting  Dr.  Philip 
Van  Ingen,  member  of  the  New  York  Milk  Committee. 

Dh.  Phiup  Van  I.vgen:  I  think  Mrs.  Putnam  and  her  committee  have  done  splendid  work  in 
Boston.  They  have  called  the  attention  of  the  whole  country  to  this  subject,  and  so  have  done  more 
than  merely  care  for  the  interests  of  the  people  in  Boston,  wonderful  as  that  work  has  been.  We  in  this 
country  are  very  proud  of  what  has  been  accomplished,  but  this  work  has  been  <lone  along  somewhat 
similar  lines,  varying  in  different  European  countries,  since  1891.  The  Maternity  Insurance  in  France 
has  been  trying  to  improve  the  chances  of  mothers  to  go  through  their  pregnancy  nonnally  and  to  give 
the  babies  born  a  better  chance  through  this  method  of  instructing  mothers  and  providing  them  w  ith  the 
means  to  stop  work  so  that  they  may  fit  themselves  for  what  they  are  to  go  through.  I  think  all  of  us 
who  have  listened  to  the  addresses  this  morning  are  struck  with  one  thing,  particularly  with  the  remarks 
of  Dr.  Hart  in  speaking  about  the  babies  who  arc  public  charges.  They  have  emphasized  the  home 
and  what  must  be  done  in  the  home.  Miss  FarrcU  has  spoken  about  instruction  of  expectant  mothers 
in  the  home.  Formerly,  when  anything  was  to  be  done,  the  only  idea  was  to  build  a  hospitjd  or  a  refuge 
or  whatever  it  might  be  called.  Now  it  seems  that  the  home  element  is  coming  in  more  and  more,  and 
we  are  now  giving  instruction  and  getting  at  the  root  of  the  matter.  We  are  trying  to  bring  about  a 
situation  where  instruction  will  do  away  « ith  the  need  of  uuich  of  the  action  hitherto  considered  neces- 
sary. 

We  have  also  heard  of  the  surprising  amount  of  mortality,  and  we  have  seen  the  proportion  of 
infant  mortaUty  in  the  first  month  of  life.  In  New  York  so  far  this  year  40  per  cent,  of  the  infant  mor- 
tality has  been  of  children  under  one  month  of  age.  In  Boston,  for  the  months  of  January,  February, 
and  March,  it  was  44  per  cent.  In  England  and  Wales,  in  the  year  1909,  for  the  entire  year,  the  Regis- 
trar General  reports  87  per  cent.  In  one  week  in  New  York  (U  per  cent,  of  the  recorded  mortality  under 
one  year  was  under  one  month  of  age. 

Last  summer  the  New  York  Milk  Committee  attempted  to  assist  the  health  department  in  carry- 
ing on  milk  stations  and  in  reducing  infant  mortality.  There  were  maintained  Si  stations  in  the  Borough 
of  Manhattan,  and  57  stations  were  maintained  altogether.  We  began  to  tabulate  our  results  early  in 
September,  m  order  that  we  might  have  something  to  set  before  the  public.  We  found  that  among  3182 
babies  under  the  care  of  the  Milk  Committee  at  their  milk  stations,  practically  only  7  per  cent,  were  under 
the  age  of  two  months,  and  under  the  age  of  one  month  occurs  40  per  cent,  of  all  the  infant  mortality. 

We  know  that  practically  all  infant  mortality  in  summer  is  due  to  two  classes  of  diseases — diarrheal 
diseases  and  general  debility,  so  called.  We  do  not  take  into  consideration  the  fact  that  the  statistics 
as  published  do  not  include  still-births.  In  New  York  city  last  year  there  were  nearly  7000  still-births 
reported.  There  were  i;«,000  births  in  all,  so  that  makes  5  per  cent,  of  all  pregnancies  resulting  in 
still-births.  If  you  compare  that  with  the  figures  you  know  for  the  deaths  under  one  month,  you  will 
find  10  per  cent,  of  all  pregnancies  resulting  in  deaths  before  the  child  is  one  month  old. 

Mrs.  Putnam  has  told  us  what  their  committee  has  been  doing  in  Boston  in  this  work  in  trying  to 
prevent  still-births  and  the  mortality  during  this  first  month,  by  teachmg  the  mother  how  to  care  for 
herself  and  to  prepare  herself  to  take  care  of  her  baby  and  to  produce  a  better  baby.  In  France  they 
have  worked  out  statistics,  and  it  has  been  found  that  an  increase  in  the  weight  of  the  babies  of  from 
G  to  8  oimces  takes  place  where  the  proper  care  is  taken,  when  the  mother  keeps  quiet  and  takes  care  of 
herself,  particularly  in  the  last  months  of  pregnancy.  In  New  York  we  are  trymg  an  experiment  along 
the  same  lines.  We  find  that  only  -i  per  cent,  of  our  babies  come  to  milk  stations  under  one  month  of 
age.  We  started  putting  two  nurses  on  this  prenatal  work,  through  the  assistance  of  Dr.  Hart  of  the 
Sage  Foundation,  in  providing  the  salaries,  and  we  later  had  to  add  another  nurse  to  this  work;  and 
during  about  four  months  we  came  into  contact  with  800  expectant  mothers,  .\bout  300  of  them  removed 
out  of  the  district  where  we  were  working,  so  we  actually  mstructed  500  mothers,  carrying  them  through 
between  two  and  a  half  and  three  months,  and  followed  them  through  one  month  after  the  baby  was 
born.     W'e  have  figures  for  these  500  mothers,  and  whereas  in  New  York  city  42  out  of  1000  babies  born 


250       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

die  in  the  first  month,  among  our  babies  the  deaths  were  16  per  1000.  Among  all  New  York  babies,  5 
per  cent,  died  before  or  at  birth.  Among  our  babies,  including  early  miscarriages  and  still-births,  we 
had  1.4  per  cent.,  and  of  these  babies  3  out  of  7  died  as  the  result  of  unexpected  conditions  at  birth. 
These  results  are  among  the  poorest  of  the  population.  We  are  down  in  the  neighborhood  of  the  Henry 
Street  Settlement,  where  the  population  ranges  from  4000  to  5000  souls  to  a  block.  We  have  now  our 
two  nurses  at  work.  During  the  first  fifteen  days  of  May  we  registered  174  new  mothers.  We  are 
planning  to  have  si.x  nurses  in  New  York  in  order  to  take  different  classes  and  nationalities  of  our  popula- 
tion, so  that  we  may  carefully  study  the  effects  of  this  prenatal  care.  We  do  not  expect  to  do  anything 
to  help  mothers,  as  Mrs.  Putnam's  Committee  is  doing  in  Boston.  W'e  do  not  intend  to  tread  upon  the 
toes  of  the  licensed  practitioner  or  midwife.  We  expect  to  cooperate  with  the  hospitals  and  the  charit- 
able organizations,  and  we  will  take  a  patient  from  anybody  and  give  her  the  very  best  care  we  can. 
We  expect  each  year  to  be  able  to  take  care,  with  our  nurses,  of  1800  cases,  for  we  think  every  nurse 
should  be  able  to  serve  ten  cases  a  day.  We  are  going  to  do  all  we  can  to  prepare  the  mother  for  her 
new  responsibilities. 

Dr.  S.  Josephine  Baker:  There  was  one  point  brought  out  which  is  very  significant  and  im- 
portant. It  is  the  fact  that  this  is  a  work  done  by  lay  women.  I  am  exceedingly  interested  in  it  from 
the  standpoint  of  the  lesson  it  gives  with  respect  to  the  work  of  the  midwife,  for  there  is  no  doubt  that 
this  has  lessened  her  practice.  I  think,  also,  that  I  see  in  this  a  prophecy  of  the  future — of  the  time 
when  women  in  clubs,  the  lay  women,  will  everywhere  realize  that  each  woman  is  her  sister's  keeper, 
and  then  we  shall  have  many  more  organizations  busy  in  this  great  work. 

Dr.  William  Woodward:  I  think  we  can  hardly  speak  too  highly  of  the  work  undertaken  in 
Boston.  I  pointed  out  yesterday  the  fact  that  a  very  large  percentage  of  the  mortality  occurring  dur- 
ing the  first  year  of  life  occurs  not  merely  during  the  first  month,  but  actually  during  the  first  day,  and 
we  must  look  to  work  such  as  has  been  described  by  Mrs.  Putnam  for  the  cure  of  that  high  mortality. 
In  connection  with  the  investigation  of  infant  mortality  during  the  first  day  of  life  that  we  have  recently 
undertaken  in  the  District  of  Columbia  we  have  come  across  a  very  interesting  parallelism  between  the 
infant  mortality  during  the  first  day  of  life  and  the  cost  of  living.  As  far  back  as  we  could  trace, 
with  any  reasonable  degree  of  accuracy,  the  mortality  rate  during  the  first  day  of  life  follows  very 
closely  the  corresponding  line  for  the  cost  of  living.  These  figures  are  extremely  accurate  for  the  past 
five  years,  and  whether  the  computation  is  made  upon  the  basis  of  the  number  of  deaths  during  the 
first  day  of  life  in  proportion  to  the  total  population,  or  upon  the  number  of  deaths  during  the  first 
day  of  life  compared  to  the  total  number  of  registered  births,  the  result  is  the  same,  and  the  curve 
runs  pretty  nearly  parallel,  so  that  we  must  try  to  discover,  if  we  can,  what  element  there  is  in  the 
cost  of  living  that  produces  this  apparent  effect. 

There  is  another  thing  that  I  would  like  to  call  to  your  attention.  I  hold  no  brief  for  the  midwife. 
We  have,  I  suppose,  about  as  poor  and  as  inefficient  a  set  of  midwives  in  the  District  of  Columbia  as 
exists  anywhere,  and  yet,  notwithstanding  the  fact  that  the  percentage  of  births  attended  by  midwives 
has  diminished  since  about  1893  from  50  per  cent,  to  15  per  cent.,  the  mortality  during  the  first  day  of 
life  has  not  diminished;  so  that  it  is  not  due  to  the  midwife  that  we  have  this  high  mortality.  Dr. 
Baker  pointed  out  a  somewhat  similar  condition  in  New  York  yesterday  when  she  stated  that  a  larger 
percentage  of  cases  of  ophthalmia  neonatorum  is  reported  from  the  practice  of  physicians  than  from  the 
practice  of  midwives.  We  must  bear  in  mind  not  only  what  Dr.  Huntington  said  concerning  the  need 
of  abolishing  midwives,  if  they  are  to  be  abolished,  but  also  the  need  for  the  provision  of  better  obstetric 
service  from  physicians  and  nurses,  and  the  work  that  Mrs.  Putnam's  society  has  undertaken  will  cer- 
tainly go  a  long  way  toward  affording,  at  least  in  the  homes  of  poor  people,  that  measure  of  care  which 
will  bring  about  as  nearly  ideal  conditions  as  possible. 

Mrs.  Wister:  Dr.  Woodward's  statement  suggesting  a  probable  relationship  between  the  cost 
of  living  and  infant  mortality  is  extremely  interesting.  We  shall  anxiously  await  the  result  of  a  further 
investigation  of  this  suggestive  problem. 

Is  there  any  further  discussion.'' 

Mrs.  Pctn.\m:  \\ith  reference  to  the  number  of  visits  to  be  expected  from  a  nurse,  our  one  nurse 
averages  ten  visits  per  day.  The  fact  that  we  have  but  one  makes  it  necessary  for  her  to  cover  the  whole 
city  of  Boston,  including  such  outlying  districts  as  Cambridge,  and  even  Jamaica  Plains.     When  she 


PROCEEDINGS  OF  COXFERENCE  ON  INFANT  HYGIENE       251 

happens  to  find  her  cases  grouped,  she  can,  of  course,  visit  a  much  larger  number.  In  one  morning,  for 
instance,  she  saw  12  cases  in  which  she  tested  the  urine  and  determined  the  blood-pressure.  She  en- 
deavors to  see  the  prospective  mothers  at  least  once  in  ten  days. 

A  Question:   Have  you  kept  any  record  of  the  infant  mortality  after  birth? 

Mrs.  Putnam:  No;  it  is  not  easy  to  follow  them  without  considerable  additional  work,  which 
we  have  not  felt  it  incumbent  upon  our  society  to  do.  I  know  that  this  mortality  must  be  low,  because 
our  percentage  of  still-births  is  only  1.9  per  cent,  as  compared  with  the  average  of  5  per  cent.  We  try 
to  get  the  figures,  but  it  is  very  difficult. 

Mrs.  Wister:  I  am  afraid  on  account  of  the  lateness  of  tlie  hour  we  must 
leave  this  very  interesting  subject,  which  I  am  sure  we  are  all  sorry  to  do.  There 
are  doubtless  many  question.s  we  would  like  to  a.sk  Mrs.  Putnam. 

I  have  much  pleasure  in  introducing  Dr.  Helen  C.  Putnam,  Director  of  the 
American  Association  for  the  Study  and  Prevention  of  Infant  Mortality,  who  will 
discuss  the  very  interesting  and  important  theme,  "Educational  Work  for  Mothers 
of  Today  and  Mothers  of  the  Future. " 


EDUCATION  FOR  BETTER  PARENTHOOD 
BY  DR.  HELEN  C.  PUTNAM 

Chairman  of  Section  on  Public  School  Prevention  of  Infant  Mortality  of  the  .\merican  Association  for 
Study  and  Prevention  of  Infant  Mortality 


Mothers  must  be  something  more  than  housekeepers;  fathers,  something  more 
than  money-getters.  Fathers  and  mothers  have  the  greatest  mission  in  the  world, 
the  greatest  vocation;  and  we  have  been  establishing  schools  for  every  kind  of 
occupation  except  for  the  greatest — home-making  and  parenthood. 

Parents  up  to  this  century  have  almost  entirely  undertaken  their  duties  with 
knowledge  incidentally  acquired.  They  have  picked  it  up,  a  little  here  and  there, 
much  of  it  being  what  they  learned  in  their  childhood  homes.  This  picked-up 
information,  according  to  the  Bureau  of  the  Census,  proves  as  wasteful  of  life  as 
was  the  picked-up  knowledge  of  nursing  before  the  days  of  training-schools. 

According  to  the  estimate  of  one  federal  authority,  we  rank  twenty-second 
below  the  best  of  the  31  civiUzed  countries  in  our  mortality  rates  for  infants;  ac- 
cording to  another,  our  most  favorable  estimate  is  about  one-third  down  the  list. 
Either  is  especially  discreditable  when  it  is  recalled  that  we  lead  all  nations  in 
national  wealth  by  a  very  generous  margin.  We  are,  too,  the  only  civilized  country 
that  has  to  estimate  its  infant  mortaUty  rate,  the  only  one  failing  to  keep  accurate 
records  of  the  birth  of  its  citizens. 

Two  million  babies  born  alive  have  died  during  their  first  year  in  the  last  ten 

years,  with  possibly  as  many  more  at  birth  and  during  the  three  preceding  months. 

Another  large  number,  estimated  at  one-seventh  of  all  conceptions,  died  during  the 

earliest  months  of  pregnancy.     In  this  last  group  many  were  deliberately  murdered — 

18 


252       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

we  have  no  means  of  knowing  the  number;  many  died  of  syphilis  in  parent  or 
grandparent.  Both  murder  and  syphilis  are  preventable  if  society  educates 
potential  parents  for  their  vocation  of  home-making.  Other  prenatal  deaths  were 
due  to  causes  largely  preventable  by  intelligent  management. 

Of  the  2,000,000  born  alive,  probably  more  than  500,000  would  still  be  living 
if  they  had  been  so  fortunate  as  to  have  been  born  in  any  one  of  11  other  countries. 
All  this  is  an  intolerable  waste  of  motherhood,  fatherhood,  and  infant  life;  of 
national  resources  and  wealth,  if  calculated  on  a  money  basis.  We  believe  from 
local  experiences  that  fully  one-half  of  our  infant  deaths  can  be  prevented  with 
sensible  use  of  elementary  scientific  methods.  It  is  very  interesting  to  note  just 
at  this  time  that  in  every  one  of  the  countries  with  lowest  rates  of  infant  and  child 
mortaUty  women  have  equal  political  power  with  men  to  control  the  living  con- 
ditions surrounding  children,  and  that  in  no  one  of  the  countries  with  higher  mor- 
tality rates  is  this  the  case.  Such  statistics  interpreted  signify  that  where  women 
are  clear  thinking  enough  to  discharge  their  responsibilities  toward  children,  and 
men  right  minded  enough  to  share  the  world's  work  on  equally  advantageous 
terms,  child  life  is  safer  and  humanity  better.  For  it  is  literally  true  that  the 
infant  mortality  rate  measures  the  intelligence,  health,  and  right  living  of  fathers 
and  mothers;  the  standards  of  sanitation  and  morals  of  communities  and  govern- 
ments; the  efficiency  of  physicians,  nurses,  health  officers,  and  educators.  Sta- 
tistics from  all  11  countries  show  that  alcoholism  and  poverty,  the  social  evil 
and  divorce,  industrial  training  and  general  education,  training  in  sanitation  and 
obstetrics,  a  few  or  several  or  all  these  important  factors  in  infant  mortality,  are 
better  controlled  and  guided  than  in  this  country.  It  is  certainly  woman's  business, 
her  motherhood  demands  it,  to  guard  the  well-being  of  children  on  every  side,  their 
well-being  that  determines  the  future  of  the  human  race. 

In  all  that  I  shall  say  on  education  for  parenthood  I  wish  to  be  understood  as 
meaning  regular  education,  standardized  and  made  a  permanent  institution  by 
government.  It  is  true  that  unoiScial  groups  in  various  places  are  through  their 
private  efforts  rendering  valuable  service  by  calling  general  attention  to  the  pos- 
sibilities for  developing  a  better  parenthood  by  class  instruction.  That,  however, 
is  not  my  topic.  I  am  discussing  the  possibiUties  for  all  the  people  in  schools  and 
classes  under  public  boards  of  education. 

Of  5,000,000  children  entering  the  public  schools,  more  than  3,000,000  drop 
out  of  primary  grades;  another  1,000,000  drop  out  of  grammar  grades.  We  have 
at  present  roughly  estimated  20,000,000  young  people  between  sixteen  and  thirty 
years  of  age  with  only  undirected  picked-up  knowledge  since  that  childhood's 
instruction  given  in  the  years  between  infancy  and  adolescence.  These  are  all 
liable  to  become  parents.  Society,  in  self-defense,  must  teach  them  right  living 
when  they  are  old  enough  to  learn.  These  are  the  years  when  home-making 
instincts  are  waking  and  strongest.  They  are,  therefore,  the  strategic  years  for 
making  such  instruction  most  profitable. 

We  have  two  stupendous  problems :  how  to  make  better  parents  of  the  children 
who  remain  in  the  schools,  and  of  those  young  people  who  dropped  out  of  elementary 


PROCEEDINGS  OF  COXFEREWE  OX  IXFAXT  EYGIEXE       253 

grades.  What  can  we  do  for  those  who  complete  the  grammar  grades  hut  do  not 
go  on  to  high  school?  As  only  a  small  fraction  of  elementary  children  enter  high 
school,  how  can  we  best  help  these  potential  fathers  and  mothers  under  fifteen 
years  of  age? 

We  know  that  in  the  brain  there  are  various  areas  controlling  each  some 
special  act  or  function.  Child  study  shows  that  certain  areas  at  certain  ages  develop 
best,  and  one  certain  age  is,  therefore,  the  opportune  time  to  present  one  certain 
line  of  instruction.  If  given  at  some  unphysiologic  period,  it  not  only  may  not 
develop  its  best,  but  may  crowd  out  ideas  that  should  occupy  attention  then. 

Is  it  wise  for  formal  education  in  these  elementary  years  to  cultivate  the  arts 
of  parenthood?  The  chief  arts  are  labor  to  support  the  family  and  the  care  of 
babies.  Or  is  it  wise,  instead,  for  formal  education  to  use  these  years  for  estab- 
lishing ideals  of  life  and  parenthood  on  sound  bases,  with  general  manual  training 
to  make  beginnings  in  executive  and  coordinating  ability? 

One  can  always  make  httle  children  eager  over  anything  by  tactful  methods. 
They  are  utterly  plastic  in  older  hands — to  the  limits  of  natural  law  which  finally 
avenges  its  own  violation.  One  can  make  them  enthusiastic  over  the  care  of 
babies  very  easily;  but  is  it  best  for  the  next  generation  that  Uttle  girls,  instead  of 
freedom,  open  air,  play,  be  taught  in  schools  to  lift,  carry,  tend,  feed,  manage 
babies?  Is  it  best  for  the  baby  to  be  cared  for  by  an  intelligent  child  or  by  an 
intelligent  mother?  Is  it  wise  for  society  to  tolerate,  or  to  encourage  through  its 
educational  system,  the  economic  or  any  other  conditions  that  se|)arate  mothers 
and  babies  by  teaching  little  girls  to  do  mothers'  work?  We  hear  much  of  child 
labor  in  factories;  but  there  is  also  a  problem  of  it  in  homes.  It  is  already  recog- 
nized in  sweat-shops  and  in  country  homes.  Do  any  sexual  mistakes  of  early 
adolescence  come  from  too  early  cultivation  of  parental  instincts  before  right 
education  has  laid  foundations  of  ideals? 

A  recent  masterly  study  of  vocational  education  in  Europe  includes  among  its 
final  recommendations  one  that  vocational  education  should  not  be  given  under 
fifteen  years  of  age;  that  these  earlier  years  are  needed  for  founding  general  in- 
telligence and  ideals  and  tastes,  and  securing  elementary  coordination  of  hand  and 
brain  centers.  If  this  is  right,  and  it  claims  to  sum  up  all  educational  experience, 
then  the  vocation  of  home-making  in  its  most  important  art — care  of  babies — does 
not  belong  in  elementary  schools.  We  are  the  only  animal,  some  one  says,  who 
works  its  young  in  the  care  of  others.     With  us  it  is  already  proving  a  blight. 

I  submit  that  girls  are  entitled  to  their  girlhood,  if  they  are  to  become  good 
mothers  in  their  turn,  as  are  boys  to  their  boyhood,  in  preparation  for  fatherhood ; 
as  are  babies  to  their  mothers  and  mothers  to  their  babies.  And  I  submit  that  it  is 
worth  while,  very  worth  while,  to  do  as  is  done  in  some  places,  secure  pensions  or 
insurance  for  mothers,  enabling  them  to  care  for  their  babies  in  homes  suitable  for 
making  citizens,  with  visiting  nurses  and  teaching  chnics  and  continuation  schools 
to  show  them  how. 

What  should  be  done  in  the  primary  and  grammar  grades  to  a  far  greater 
extent  than  now  is  to  estabUsh  habits  in  hygiene  and  sanitation,  knowledge  of  the 


254       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

natural  laws  of  nutrition  and  reproduction  in  plant  and  animal  kingdoms  (including 
man,  of  course),  elementary  manual  skill,  including  sew-ing  and  cooking  and  clean- 
ing; and  equally  important  it  is  to  establish  the  ideal  of  life  as  a  trust  from  an 
infinite  host  of  mothers  and  fathers  who  have  gone  before,  to  be  guarded  and 
bettered  in  one's  turn,  and  passed  along  to  children  infinitely. 

We  can  no  longer  allow  education  to  cease  at  or  before  adolescence,  which  has 
its  special  needs  for  knowledge  that  could  not  be  given  earlier.  Humanitarian 
interests  have  lagged  behind  financial  in  efforts  to  continue  education  for  those 
over  fifteen  years  of  age.  Trade  schools  under  varying  names  are  much  better 
established  than  instruction  in  the  interests  of  home-making. 

There  are  two  questions  that  at  once  present  themselves  in  this  immense  task 
of  meeting  adolescent  and  adult  needs  of  a  population  equaling  the  present  school 
population.  Where  is  the  money  to  come  from,  and  where  the  teachers?  Already 
the  federal  government,  through  its  Department  of  Agriculture,  is  jjromoting 
vocational  education  for  the  farm,  including  home  economics,  by  appropriating 
millions  of  dollars.  There  is  also  a  movement  on  foot  to  assist  States  financially 
in  establishing  continuation  schools  under  State  boards  of  education,  these  schools 
to  include  instruction  in  home-making.  To  lessen  mortality  and  morbidity  rates 
and  to  improve  the  quality  of  its  citizens  is  at  last  being  recognized  as  of  not  less 
national  importance  than  to  increase  wealth.  With  federal  assistance  and  local 
cooperation  in  various  directions  the  money  will  be  found. 

The  need  of  able  teachers  is  much  more  difficult  to  meet.  Continuation  in- 
struction is  coming  by  rapid  evolution,  however,  not  by  revolution,  and  the  prep- 
aration of  teachers  is  already  beginning  in  universities,  colleges  (including  agricul- 
tural), normal  and  special  schools.  The  outline  of  one  such  course  for  university 
women  will  give  an  idea  of  the  trend  of  this  preparation  and  the  possible  trends 
in  high  school  and  in  continuation  work  for  women  between  sixteen  and  thirty 
years  of  age.  All  such  to  be  effective  must  be  sufficiently  elastic  for  a  wide  range 
of  age,  intelligence,  and  social  needs. 

In  this  course  the  central  thought  of  four  years'  instruction  is  "improving  the 
individual  so  that  future  generations  may  attain  a  higher  level  than  those  preceding 
them" — a  marked  contrast  to  present  educational  aims  merely  recognizing  the 
individual's  interests.  The  study  of  social  relations  of  the  home  comes  after  two 
and  a  half  years  in  chemistry,  physics,  biology,  bacteriology,  physiology,  and 
household  arts  and  management.  The  development  of  the  infant  before  birth 
is  first  discussed,  and,  as  they  have  seen  these  beginnings  many  times  in  plant  and 
animal  life  in  their  biologic  laboratory,  it  is  a  simple  matter  to  adapt  that  knowledge 
to  human  life. 

The  inheritance  of  acquired  and  inherent  characteristics  is  discussed,  and  the 
effects  on  germ  plasm  of  alcoholism,  syphilis,  drug  habits.  They  learn  the  fact  that 
drunkards,  insane,  feeble-minded,  habitual  criminals,  and  sexually  depraved  men 
and  women  usually  have  children  with  defective  nervous  systems,  and  usually 
breed  their  kind.  They  learn  the  real  significance  of  good  stock  on  the  father's 
side  and  on  the  mother's.     Teachers  with  this  knowledge  can  do  much  directly  and 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       255 

indirectly  in  mothers'  and  parents'  clubs,  and  with  children,  to  develop  through  the 
country  right  ideas  of  marriage  to  replace  the  unwholesome  ones  now  so  common 
among  young  people  and  among  their  parents,  who  should  know  and  teach  their 
children  better. 

There  is  a  far-reaching  significance  in  their  enumeration  of  syphilis  and  gono- 
eoccus  infection  (not  gonorrhea,  one  of  its  manifestations)  among  ordinary  con- 
tagious disease,  and  in  their  study  of  these  statistics  as  well  as  the  others  in  govern- 
ment and  scientific  reports,  and  their  relation  to  the  home;  for  they  are  not  less 
than  five  times  as  prevalent  as  tuberculosis  and  all  other  contagions  together,  and 
they  injure  wives  and  children  to  an  extent  not  possible  to  estimate.  They  are  the 
cause  of  many  deaths  before  birth  (characteristic  of  syi)hilis);  of  the  death,  degen- 
eracy, blindness  of  many  infants  in  the  first  years  of  life;  of  many  childless  families 
and  one-child  families  (a  peculiarity  of  gonococcus  infection);  of  the  invalidism, 
surgical  mutilation,  and  death  of  many  wives;  of  much  insanity,  rheumatism, 
heart  disease,  and  other  physical  and  mental  incapacity;  of  much  divorce,  un- 
happiness,  crime;  of  cx])cnditures  of  large  public  and  i)rivate  funds  and  effort  on 
misfortunes  that  can  and  should  be  prevented.  They  have,  through  slow  processes, 
exterminated  ancient  nations  and  modern  communities.  If  they  increase  through 
the  next  quarter  century  at  the  rate  of  the  last,  it  would  seem  as  if  this  nation,  too, 
must  decline.  In  my  own  professional  exi)erience,  as  in  that  of  other  physicians, 
the  fate  of  married  sister  or  friend  has  i)revented,  is  preventing,  marriages. 

The  students  see  logically  that  control  of  these  contagions  must  be  the  same 
as  control  of  smallpox,  scarlet  fever,  and  any  other  of  the  several  that  we  have 
almost  eliminated — every  case  must  be  reported  to  the  board  of  health.  That  this 
so  evident  first  step  is  not  taken  is  due  to  the  fact  that  boards  of  health,  who  are 
charged  with  administration  of  health  laws,  do  not  enforce  the  law  requiring  this; 
that  in  the  majority  of  States  these  laws  have  still  to  be  enacted;  that  the  great 
majority  of  physicians  will  not  report  these  cases  because  they  are  almost  always 
connected  with  illegal  sex  relations  of  men  which  they  wish  concealed;  and  that 
city  governments,  through  their  courts  and  police,  permit  these  dangerous  men  to 
pass  freely  about  in  the  community  and  into  the  homes  where  prostitutes  never  go, 
because  of  the  established  idea  that  men  may  lead  irregular  lives  not  permitted 
women — the  so-called  double  standard  of  morals. 

Education  for  parenthood  necessarily  brings  with  it  the  insistence  that  govern- 
ment shall  protect  parenthood  from  these  contagions  and  their  evils;  and  as  govern- 
ment does  not  do  so,  never  has  been  known  to  do  so,  possibly  never  can  do  so,  as 
the  great  majority  of  men  claim,  women  in  various  countries  in  increasing  numbers, 
and  with  the  cooperation  of  many  of  the  best  men  (but  invariably  fought  by  saloon, 
gambling,  and  other  vicious  elements)  are  securing  the  political  right  to  protect 
their  own  and  their  children's  lives  according  to  their  duty  to  the  laws  of  God. 
There  is  no  doubt  in  the  minds  of  keen  students  of  social  relations  that  political 
dominance  of  sex  is  wholly  an  evil  and  to  both  sexes;  that  the  only  right  dominance 
is  wisdom,  of  which  education  and  experience  are  giving  women  full  share  with 
men.     Civil  law  made  by  men  not  based  on  biologic  law  which  women  are  learning 


256       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

ends  ill  disaster.  The  wise  intelligence  of  mothers,  of  professional  women  in  the 
ministry,  in  law,  in  medicine,  in  sociology,  and  in  education;  laboring  women  with 
their  sense  of  wronging  their  children  when  they  go  out  from  the  home  to  earn  their 
food;  and  the  other  mothers  who  see  their  dearest,  without  legal  protection  or 
redress,  contaminated  body  and  soul,  out  of  the  under  world  whose  pollution  reaches 
all  classes — these  are  concentrating  on  the  demand  and  are  winning  it.  It  is  an 
indispensable  step  toward  the  establishment  of  right  sex  relations. 

After  this  study  of  heredity  comes  study  of  physical  and  mental  development 
of  child  and  adolescent;  the  influence  of  city  life  and  country  life  on  development, 
with  school  statistics  of  the  rates  of  growth  of  boys  and  of  girls;  the  kind  of  educa- 
tion adapted  to  the  different  kinds  of  children;  infant  mortahty,  the  effect  on  it 
of  women's  work  outside  the  home,  and  of  different  kinds  of  occupations  of  mothers 
before  the  child  is  born;  governmental  and  social  efforts  to  reduce  infant  mortahty; 
the  pension  system  for  mothers,  paying  a  small  sum  enabling  them  to  stay  at  home 
and  nurse  their  babies,  thus  saving  citizens  to  the  State  as  governments  have 
hitherto  pensioned  soldiers  who  destroy  citizens;  the  effects  of  institutional  care 
of  babies  and  children  on  death-rate  and  on  development,  the  cause  of  reduced 
birth-rates,  and  the  duty  of  the  educated  in  the  preservation  of  the  race;  children 
in  industry,  and  its  legislation;  the  housing  problem ;  child  psychology;  children's 
^^ces;  education  of  the  will;  a  study  of  nervous  states  and  their  hygiene. 

Among  the  theses  presented  by  these  students  for  their  degrees  was  one  ex- 
cellent study  of  infant  mortality  by  wards  in  that  city.  Another  thesis  dealt  with 
contagious  diseases  in  the  home,  including  syphilis  and  gonococcus  infection. 
Another  girl  made  a  special  study  of  housing  conditions  in  her  city;  another,  of 
the  milk  supply.  This  practical  education  of  teachers  and  future  mothers  is 
growing  throughout  the  country. 

To  make  instruction  in  the  care  of  children  as  effective  as  possible  this  and 
other  similar  courses  utilize  neighboring  hospitals,  or  day  nurseries,  or  kindergartens 
and  other  institutions.  In  connection  with  every  normal  school  there  is  always  a 
practice  school  of  children,  and  medical  inspectors  are  growing  into  teachers  of 
teachers  in  many  such. 

Instead  of  a  few  score  of  women  trained  like  this,  we  need  many  thousands. 
We  also  need  proper  training  for  fatherhood  in  other  directions  than  money-getting. 
Wealth,  or  even  a  livelihood,  is  not  more  important  than  this,  as  education  by  its 
sins  of  omission  lets  us  infer.  BiUions  are  spent  annually,  largely  out  of  shallow 
purses,  in  destroying  the  home;  on  alcoholic  and  other  drug  habits,  prostitution  and 
gambling,  evil-breeding  reading  and  recreation,  inefficient  pohtieal  institutions 
and  officials.  We  must  no  longer  let  the  years  of  adolescence  and  young  adult  life 
run  to  waste  educationally  in  either  boy  or  girl,  as  we  have  been  doing  for  so  many 
millions,  when  they  are  the  crux  of  the  problem  of  better  marriages  and  better 
children. 

Mrs.  Wister:  We  have  greatly  enjoyed  Dr.  Putnam's  address.  The  subject 
of  these  continuation  schools  and  home-making  forces  is  of  great  interest  to  the 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       257 

large  number  of  Philadelphians  associated  with  our  various  civic  and  educational 
bodies.  I  hope  that  Dr.  Putnam  may  be  able  to  convert  our  Federal  authorities 
in  Washington  to  the  necessity  of  the  cause  she  so  ably  represents  as  successfully 
as  she  has  converted  us.  I  am  sure  we  shall  see  the  establishment  of  the  kinds  of 
schools  Dr.  Putnam  advocates. 

We  happen  in  this  city  to  have  attained  great  distinction  in  many  parts  of  the 
United  States  because  of  the  work  done  by  one  woman  in  the  Home  and  School 
League  and  the  After  School  Club.  It  is  not  necessary  for  me  to  introduce  to  you 
Mrs.  Edwin  C.  Grice. 

DISCISSION  ON  DR.  HELEN  C.  PUTNAM'S  PAPER 

Mrs.  Edwin  C.  Grice:  I  fancy  we  had  better  not  take  the  time  for  a  discussion  of  all  the  points 
brought  out  in  Dr.  Putnam's  paper,  because  of  the  lateness  of  the  hour,  but  there  are  two  or  three  points 
that  I  should  like  to  refer  to  briefly. 

One  might  think,  after  hearing  this  discussion,  that  everybody  lived  in  a  congested  district  in  the 
city,  and  that  every  baby  was  born  into  a  poor  home.  It  does  seem  to  me  that  the  time  has  come  for 
us  to  look  after  children  wljo  do  not  happen  to  have  been  born  in  these  congested  districts.  Is  it  not  a 
mistake  to  over-emphasize  one  class?  Is  there  not  a  woman  in  this  room  who  knows  a  neglected  baby 
of  the  rich?  I  am  sure  you  do.  I  think  we  must  consider,  to  some  extent,  at  least,  the  education  of 
this  class  of  the  community. 

I  would  take  exception  to  Dr.  Putnam's  belief  that  it  is  only  during  the  period  of  adolescence  that 
we  should  impress  upon  our  young  people  the  function  of  parenthood.  Have  you  never  seen  the  baby 
girl  "mother"  her  doll?  Have  you  never  seen  the  baby  boy  do  exactly  the  same  thing?  Now,  I  believe 
that  it  is  at  this  impressionable  period  of  the  child's  life  that  one  can  lay  the  foundations  of  the  education 
that  we  need  for  the  home.  Certainly,  we  want  to  make  use  of  that  period,  for,  as  a  psychological  fact, 
as  well  as  through  personal  experience,  we  know  that  the  earliest  impressions  are  the  ones  that  are  the 
most  firmly  fixed  in  the  mind,  and  that  are  the  hardest  to  eradicate  in  later  life. 

The  third  point  that  I  want  to  emphasize  is  that  there  seemed  to  be  just  a  little  too  much  of  the 
professional  side  in  the  paper  presented.  I  will  say  to  the  professional  folk,  you  are  doing  a  splendid 
work,  and  you  are  giving  your  hearts  to  that  work,  but  you  are  such  a  small  body  when  you  consider 
the  great  nation  of  homemaking  people  who  do  not  know  even  the  terms  you  use.  So  you  must  train 
the  teachers  to  a  sense  of  the  fitness  of  things,  to  the  extent  that  they  can  talk  to  us  uninitiated  folk  in 
our  own  language,  so  that  we  will  underst^ind. 

Naturally,  the  public  school  authorities  cannot  take  over  all  the  things  that  the  volunteer  workers 
want  taken  over.  There  is  too  much  to  be  done  at  one  time.  Here  in  Philadelphia  we  have  been  trying 
an  experiment,  and  it  has  proved  to  be  such  a  success  that  we  are  going  to  repeat  and  extend  it  next 
winter.  Near  a  certain  school,  we  noticed  conditions  which  needed  improvement,  so  a  house  was  taken 
next  to  the  school,  and  a  homemaking  center  created.  In  this  "home"  our  girls  are  trained  in  mother- 
craft  and  home  work.  They  go  from  the  school  to  this  house  in  classes,  at  the  convenience  of  the  princi- 
pal. Their  duties  in  the  "home"  are  very  much  like  those  of  their  own  homes.  Of  course,  babies  come 
there,  because  home  would  not  be  anything  without  baby  life  in  it.  They  do  not  come  by  hundreds, 
as  they  do  in  New  York,  but  they  come  to  us  by  the  dozens,  and  they  are  weighed,  and  their  mothers 
are  talked  to  and  helped,  and  other  mothers  are  invited  to  witness  the  work.  The  girls  of  the  school 
handle  the  babies  as  little  mothers  should.  This  work  has  been  so  successful  that  next  year,  through  the 
kindness  of  a  generous  Philadelphian,  who  has  given  us  some  $4000,  we  are  going  to  open  another  "home," 
and  make  it  the  center  of  homekeeping. 

This  is  a  suggestion,  that  is  all,rbut  it  seems  to  us,  while  you  are  waiting  for  the  Federal  Govern- 
ment to  give  you  the  funds  for  the  larger  work,  it  might  be  wise  to  take  up  some  such  smaller  phase  of  it, 
where  the  opportunity  exists.  Here  is  certainly  a  place  where  public-spirited  citizens  can  do  a  great 
deal  of  good  to  the  community. 


258       REPORT  OF  THE  PHILADELPHIA  RABY  SAVING  SHOW 

Lastly,  I  do  not  know  how  many  of  you  have  read  the  American  Magazine  for  this  month,  and 
have  seen  the  article  by  Miss  Tarbell  on  the  "Irresponsible  Woman  and  the  Friendless  Child."  Those 
who  have,  whether  they  be  social  worker  or  professional  guide,  must  feel  that  there  is  still  an  untouched 
field  of  effort  waiting  some  worker's  hand.  Some  effort  should  be  made  to  arouse  the  great  mass  of 
irresponsible  women  and  relate  them  for  good,  in  a  real  way,  to  the  friendless  children  in  our  midst. 
Awaken  these  women  to  a  sense  of  the  needs  of  child  life  about  them.  Teach  them  that  the  spirit  of 
childhood,  like  some  frail  flower,  requires  most  delicate  handling.  Arouse  in  them  that  sense  of  woman- 
hood which  spells  most  truly  motherhood.  This,  to  my  mind,  is  almost  the  greatest  home  education 
which  can  be  accomplished  today. 

Mrs.  Wister;  How  sorry  we  all  are  that  we  have  not  the  time  for  more 
inspiring  words  from  Mrs.  Griee,  and  how  sorry  I  am  that  I  cannot  give  our  dis- 
tinguished visitors  a  description  of  some  of  the  important  things  she  has  done  for 
Philadelphia. 

The  next  name  on  our  program  is  familiar  to  every  one  interested  in  and  in 
sympathy  with  the  great  play  movement.  Every  one  who  has  felt  the  pervading 
influence  of  that  movement  will  recognize  the  name  of  Mrs.  Gulick  as  standing  out 
most  prominently  in  the  movement  that  is  known  as  the  "Camp  Fire  Girls."  It 
was  expected  that  the  Boy  Scouts  movement  would  appeal  to  people  because  most 
people  are  naturally  interested  in  boys,  but  I  think  many  of  us  were  surprised  at 
the  prompt  response  given  to  the  corresponding  movement  among  the  girls.  Not 
more  than  two  weeks  ago,  in  Savannah,  I  heard  the  people  saying  that  Savannah 
welcomes  the  Scout,  but  is  carried  away  with  the  Camp  Fire  movement,  and  I 
think  that  is  true  of  many  other  places  in  this  country.  It  gives  me  much  pleasure 
to  present  to  you  Mrs.  Luther  H.  GuUck. 


THE  VALUE  OF  RECREATION  IN  RELATION  TO 
INFANT  MORTALITY 

BY  MRS.  LUTHER  H.  GULICK 


I  did  not  expect  to  be  introduced  in  this  way,  as  the  leader  of  the  Camp  Fire 
movement,  although  naturally  I  expected  to  say  a  good  deal  about  that  movement 
in  my  few  remarks.  My  husband,  last  week,  was  asked  to  make  an  address  in 
Albany  about  medical  inspection  in  schools.  On  his  return,  I  asked  him  if  he 
talked  about  Camp  Fire  Girls?  You  can  imagine  his  reply.  As  a  matter  of  fact, 
he  makes  it  a  point  to  say  something  on  that  subject  no  matter  what  may  be  the 
particular  theme  assigned  him,  and  so  I  suppose  I  will  say  something  about  the 
Camp  Fire  Girls,  even  though  our  subject  today  is  the  value  of  recreation  in 
relation  to  infant  mortality. 

Several  months  ago  Dr.  Gulick  received  a  letter  from  a  principal  of  one  of  the 
large  New  York  schools  asking  him  if  there  would  be  an  opportunity  for  the  girls 
who  are  members  of  the  Little  Mothers'  League  to  receive  honor  in  the  Camp  Fire 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       259 

Girls.  Naturally,  this  letter  delighted  us.  We  went  to  see  the  principal  and 
heard  from  her  at  first  hand  the  work  of  this  particular  league.  It  seemed  to  us 
that  in  meeting  this  principal  we  were  meeting  a  mother — one  of  these  new  motliers, 
a  universal  mother,  or,  to  use  a  better  term,  a  community  mother.  The  organiza- 
tion of  Camp  Fire  Girls  is  very  glad  to  cooperate  with  such  work.  They  are  ar- 
ranging to  cooperate  with  the  Fruit  and  Flower  Guild  and  other  similar  organiza- 
tions. 

To  hear  Miss  Knox  tell  about  the  work  in  her  school  was  to  me  one  of  the  most 
hopeful  signs  of  what  future  motherhood  is  to  be.  The  pageant  of  enhghtened 
and  unenlightened  days  was  a  wonderful  example  of  how  children  can  be  taught 
necessarj'  things  in  a  beautiful  way.  This  work  has  been  brought  about  through 
the  efforts  of  Dr.  S.  Josei)hine  Baker,  of  the  New  York  Department  of  Health.  The 
argument  made  for  the  founding  of  this  League  was  a  sound  one.  The  care  of  the 
youngest  children  of  the  large  families,  often  so  wTctchedly  poor,  is  left  to  the  eldest 
daughter,  frequently  not  much  out  of  infancy  herself.  To  the  ignorance  of  these 
young  girls  has  been  attributed  a  large  percentage  of  the  infant  mortality.  To 
quote  from  Dr.  Baker:  "If  these  girls,  the  little  mothers  of  their  small  brothers 
and  sisters,  are  unwittingly  one  of  the  causes  of  infant  mortality,  why  not  make 
them  one  of  the  factors  in  reducing  it.'"  Dr.  Baker  doubtless  has  told  you  some- 
thing of  the  wonderfully  good  work  these  young  girls  are  doing. 

One  thing  that  impressed  me  most  in  regard  to  the  pageant  of  the  little  mothers 
was  a  song  which  James  Oppenheim  wrote  for  the  Little  Mothers'  League  of  School 
15.  As  Dr.  Baker  did  not  give  you  that  poem,  I  want  to  read  it  to  you:  This 
is  what  the  girls  sang  in  that  pageant: 

LITTLE  MOTHERS'  LEAGUE  SONG 
Upon  our  faces  shines  a  light 

Our  toiling  mothers  have  not  seen; 
America's  high  torch  of  white 
We  bring  to  pierce  their  troubled  night. 

We  little  mothers  of  Fifteen, 

Of  dear  Fifteen,  of  dear  Fifteen. 
And  so  our  sisters  and  our  brothers 
Have  each  of  them  two  loving  mothers 

To  make  them  grow  up  sweet  and  clean. 

And  in  our  homes  new  glories  start 

And  child  and  mother  on  us  lean 
0  Schools,  that  taught  us  this  sweet  art. 
We  lay  our  hearts  upon  your  heart. 

We  little  mothers  of  Fifteen, 

O  dear  fifteen,  O  dear  Fifteen. 
Your  radiant  light,  your  loving  power 
Shall  teach  our  spirits  till  we  flower 

In  womanhood,  superb,  serene. 

If  we  can  get  children  to  sing  these  ideas,  we  have  gone  a  great  deal  farther 
than  in  giving  them  merely  the  material  facts  in  regard  to  the  care  of  babies. 


260       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

I  have  here  two  compositions  selected  from  a  great  many  written  by  members 
of  the  Little  Mothers'  League,  which  seem  to  me  to  illustrate  this  idea  of  just  what 
community  mothering  really  is.  These  little  girls  are  becoming  real  community 
mothers.     The  first  is  by  Lillian  Newman,  of  the  eighth  grade,  who  says: 

"The  work  of  the  Little  Mothers'  League  has  been  a  success  throughout  the 
four  or  five  years  we  have  established  it.  We  are  being  taught  each  week  how  to 
care  and  feed  babies.  We  meet  on  Monday  afternoon  at  three  o'clock.  The 
president  calls  the  meeting  to  order,  and  we  begin  our  daily  task.  Our  director 
is  Mrs.  Kaiser;  she  suggests  that  we  should  cut  out  clippings  from  newspapers 
about  anybody  who  is  trying  to  help  save  babies'  lives.  On  March  27,  1912,  we 
had  a  pageant  describing  what  members  of  the  Little  Mothers'  League  do  in  trying 
to  save  babies.  Every  four  weeks  we  have  a  meeting  in  the  assembly  because' Dr. 
Pick  speaks  to  us  about  babies'  care.  He  told  us  that  a  baby  of  two  or  three 
months  should  have  more  water  than  milk,  and  babies  about  six  or  seven  months 
should  have  more  milk  than  water.  He  also  said  that  we  should  use  a  round  bottle 
to  feed  the  baby,  because  if  we  use  a  square  bottle,  it  is  bad  to  clean  the  bottle 
because  of  the  corners.  Dr.  Pick  told  us  that  before  giving  the  baby  a  nipple  we 
should  wash  it  well.  One  of  the  members  cut  out  a  clipping  from  a  newspaper 
about  Mr.  Isadore  Straus,  who  died.  He  left  a  large  sum  of  money  for  the  care 
of  babies. 

"Our  L.  M.  L.  has  been  one  of  the  oldest  and  largest  in  the  city  of  New  York. 
Nathan  Straus  has  helped  many  a  baby  in  New  York  city,  and  we  older  girls  are 
trying  to  help  save  more  babies  than  what  Nathan  Straus  did.  So  far  our  club 
has  been  a  great  success,  and  I  hope  it  will  be  a  greater  success  by  the  next  year. " 

Here  is  the  other  composition,  written  by  MoUie  Zelt,  of  the  fifth  grade: 

"I  think  it  is  very  kind  of  the  Little  Mothers'  League  to  teach  us  how  to  save 
the  lives  of  babies. 

"One  day,  while  I  was  doing  my  lessons,  our  neighbor  came  in  and  told  my 
mother  that  her  baby  was  sick.  My  mother  asked  her  what  ailed  the  baby.  She 
told  my  mother  that  it  was  always  vomiting.  I  heard  her  and  asked  her  what  she 
gave  the  baby  to  drink.  She  said  she  used  bottled  milk.  I  asked  her  from  what 
station  she  bought  it,  and  she  said  she  used  grocery  milk.  I  understood  what  ailed 
the  child  at  once.  Then  I  asked  her  to  show  me  the  bottle.  I  went  into  the  house 
and  saw  it  was  a  square  bottle.  I  told  her  that  a  square  bottle  wasn't  good  for  the 
baby's  health,  because  if  she  washed  the  bottle,  the  dirt  would  be  left  in  the  corners. 
I  asked  her  why  she  didn't  use  Straus's  milk.  She  said  she  never  heard  of  it.  I 
told  her  if  she  wanted  her  child  to  feel  well,  she  had  better  use  it.  She  asked  where 
it  was  to  be  gotten,  and  I  told  her  it  was  in  Seventh  Street  Park.  She  used  the 
milk  a  whole  week,  and  at  the  end  of  the  week  found  that  the  child  was  getting 
better.^  She  came  into  my  house  and  thanked  me  for  what  I  had  done.  She  used 
Straus's  milk  for  all  her  children  and  recommends  it  to  other  people." — Mollie 
Zelt. 

The  child  today  does  not  spend  its  entire  time  at  its  mother's  knee.  It  is  sent 
out  to  kindergartens,  to  playgrounds,  to  be  entertained  and  taught  by  trained 
workers,  by  community  mothers.  One  of  the  objects  of  the  Little  Mothers'  League 
is  not  alone  to  help  save  the  little  brothers  and  sisters  of  the  home,  but  to  acquire 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       261 

knowledge  and  training  for  future  motherhood,  which  is  also  being  put  to  service 
where  needed  in  the  comnumity. 

The  aim  of  the  Camp  Fire  organization  is  to  fill  the  gap  between  childhood 
and  womanhood,  and  the  still  greater  and  wider  gap  between  girlhood  and  mother- 
hood, with  the  beautiful,  wholesome  things  of  life,  teaching  girls  not  alone  feminine 
accomplishments,  but  human  life  tasks.  Training  them  not  so  much  for  the  home, 
but  for  the  community,  which  is  the  larger  home,  not  so  much  for  individual  mother- 
hood, but  for  the  universal  motherhood. 

In  locahties  where  the  .schools  are  not  taking  up  this  work,  and  there  are,  I  am 
sorry  to  say,  too  few  Little  Mothers'  Leagues,  the  Camp  Fire  Girls  plan  to  have 
mothers  give  the  girls  this  instruction.  The  organization  is  endeavoring  to  restore 
some  of  the  teaching  functions  to  mothers.  A  mother  with  modern  methods  in 
the  care  of  her  children  will  be  asked  by  the  Guardian  of  the  Fire  (as  the  leader 
of  a  Camj)  Fire  is  called)  to  give  instructions  in  the  feeding  or  bathing  of  the  infant, 
or  the  importance  of  recording  weights  and  heights  of  infants.  All  girls  need  this 
instruction  even  though  they  may  not  have  the  care  of  their  little  brothers  and 
sisters.  We  do  not  make  this  point  in  the  movement  too  sharply  defined,  for  we 
do  not  think  it  wise  to — all  we  do  is  to  give  an  honor  to  the  girl  who  learns  and 
performs  the  various  things  we  have  outHned  for  her. 

In  joining  the  organization  the  girl  has  only  to  learn  and  repeat  the  Wood 
Gatherer's  Desire,  but  for  the  next  rank  that  of  Fire  Maker. 

Among  the  requirements  a  girl  must  know  the  chief  causes  of  infant  mortality 
in  summer,  and  tell  how  and  to  what  extent  it  has  been  reduced  in  at  least  one 
American  community.  This  covers,  of  course,  a  knowledge  of  personal  hygiene, 
diet,  proper  clothing,  ventilation,  and  the  value  of  fresh  air. 

In  the  list  of  elective  honors,  required  to  win  promotion,  there  are  included  the 
following  tests  involving  the  care  of  the  baity: 

1.  Know  how  to  care  for  a  baby's  bed. 

2.  Know  how  milk  should  be  prepared  for  a  six-months'-old  baby;  know 
what  is  good  milk  for  a  baby  a  year  old,  and  how  it  can  be  tested. 

3.  Know  how  much  a  baby  should  gain  in  weight  each  week  for  the  first  six 
weeks,  in  height  for  each  month  for  the  first  year. 

The  relation  of  weight  to  disea.se  and  vitafity. 

4.  Know  and  describe  three  kinds  of  cries  of  a  baby  and  the  cause  of  each. 

5.  Care  for  a  baby  for  an  average  of  an  hour  a  day  for  a  month. 

6.  Make  a  practical  set  of  playthings  for  a  child  three  years  old. 

7.  Make  a  set  of  baby-clothes. 

Sleeping,  feeding,  health,  amusement,  and  clothing;  this  covers  the  practical 
and  material  needs  of  babyhood.  But  behind  the.se  direct  tests  in  the  actual  care 
of  babies  there  are  ones  of  greater  importance,  tests  in  eugenics,  which  will  help  to 
show  the  girls  the  effects  of  heredity  and  environment. 

By  making  practical  tests  in  the  value  of  pedigreed  seeds  and  pedigreed  animals, 
as  against  the  net  results  of  the  success  with  those  not  pedigreed,  a  tangible  appU- 
cation  of  this  most  important  factor  is  developed. 


262       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

An  honor  is  given  for  experiments  with  a  garden  planted  with  good  seeds  and 
accounting  the  results,  also  for  experiments  showing  the  influence  of  cultivation 
and  environment  on  seeds  not  good.  She  plants  a  plot  with  seeds  treated  with 
bacteria  solution,  and  another  not  so  treated,  and  watches  results,  which  experi- 
ment wins  an  honor  and  serves  to  point  toward  the  value  of  cultivation  and  care 
as  to  the  ultimate  effects  on  reproduction  of  life.  The  demonstrating  in  nature 
of  the  value  of  some  one  factor  of  heredity  or  environment,  or  in  some  strain  of 
animals  as  to  the  effect  of  breeding  to  health,  endurance,  length  of  life,  color,  form, 
or  effect  of  altered  habits,  is  only  symbohc.     Its  object  is  an  illustrative  one. 

The  whole  purpose  of  the  Camp  Fire  Girls  is  one  to  build  up  an  all-round 
character.  Our  physical  tests  are  of  the  habit-forming  kind.  We  give  no  honors 
for  running  certain  distances  in  a  given  time,  or  for  jumping  certain  heights,  but 
we  do  give  honors  to  girls  who  keep  well,  and  who  do  the  things  for  bringing  this 
to  pass.  To  be  free  from  colds  three  consecutive  months  during  the  winter  months; 
not  to  miss  school  or  business  for  two  months;  for  walking  40  miles  in  ten  con- 
secutive days.  A  telephone  girl  in  my  husband's  oflSce  recently  walked  47  miles 
in  ten  consecutive  days  in  order  to  win  this  particular  honor. 

In  one  of  the  slum  settlements  a  group  of  Camp  Fire  Girls  are  having  real 
romantic  pleasure  in  this  walking  test.  They  coimt  the  number  of  blocks  they 
have  walked  during  each  day  and  report  the  amount.  They  know,  as  they  have 
never  known  before,  the  number  of  blocks  to  a  mile.     These  are  working  girls. 

In  introducing  business  honors  into  the  organization  the  object  is  a  double 
one:  To  teach  girls  to  acquire  orderly  minds  for  their  present  needs  and  to  aid 
the  next  generation  to  more  readily  grasp  the  details  of  whatever  occupation  into 
which  their  environment  may  thrust  them.  Mr.  Williams  Hard,  in  his  "Women 
of  Tomorrow,"  claims  that  a  woman  with  a  business  career  behind  her  is  better 
fitted  to  rear  sons  than  the  woman  without  this  training.     This  is  obvious. 

By  this  same  scale  of  measurement  a  woman  with  training  for  a  love  of  out- 
of-doors,  who  has  found  romance  in  daily  life,  and  enjoyment  in  all  the  wholesome 
activities  and  occupations  of  womanhood,  is  of  necessity  better  equipped  to  fulfil 
the  functions  of  motherhood  than  the  young  girl  brought  up  in  an  atmosphere  of 
artificialities.     This,  too,  is  obvious. 

Our  program  is  for  all  kinds  of  girls,  those  who  work  for  their  living  as  well  as 
those  who  do  not,  whom  we  sometimes  falsely  call  the  more  favored  ones.  It  is 
the  hope  of  this  organization  to  bind  all  girls  together  in  one  great  sisterhood;  to 
teach  loyalty  to  each  other,  and  by  the  costume  and  insignia  of  the  organization 
to  help  girls  stand  together  and  to  be  worthy  of  being  a  link  in  the  chain  of  life. 

Aside  from  direct  tests  and  honors  given,  the  program  is  planned  to  fill  the 
girl  with  wholesome  ideas  of  a  Ufe  balanced  to  meet  all  requirements. 

If  the  girls  take  as  their  watchword,  "Work,  Health  and  Love,"  and  put  into 
practice  the  ideas  represented  by  these  words,  there  is  a  wonderful  possibility  of 
changing,  of  beautifying,  the  whole  character  of  the  next  generation. 

Mrs.  Wister:   We  have  listened  to  this  address  with  great  interest.     I  only 


PROCEEDINGS  OF  CONFERENCE  ON  INFANT  HYGIENE       263 

wish  it  were  earlier  in  the  day,  so  that  wc  could  hear  a  great  deal  more  about  this 
important  subject. 

Those  who  have  lived  in  Philadelphia  any  length  of  time,  and  can  look  back 
fifteen  or  twenty  years,  or  longer,  are  impressed  with  the  wonderful  change  that 
has  taken  place  in  the  attitude  of  our  government  toward  the  problems  of  health 
and  charities.  It  is  a  wonderful  and  very  sudden  change.  Our  present  Director, 
Dr.  Neff,  has  always  taken  an  especial  interest  in  baby  saving  and  baby  feeding. 
It  gives  me  great  pleasure  to  introduce  the  Assistant  Director  of  the  Department 
of  Public  Health  and  Charities,  Mr.  Alexander  M.  Wilson,  who  will  discuss  Mrs. 
Gulick's  paper. 

Mr.  WiiaoN:  If  there  be  any  virtue  in  brevity,  I  will  try  to  find  it.  I  have  been  very  much 
interested  in  this  matter  of  recreation  and  the  prevention  of  infant  mort-tlity,  but  I  will  confine  myself 
solely  to  the  matter  of  play.  I  am  sorry  that  Mrs.  Gulick  did  not  tell  us  more  of  the  recreational  side 
the  Camp  Fire  movement.  I  am  immensely  interested  in  the  Hoy  Scout  movement,  particularly  in  the 
manner  in  which  it  takes  the  boy  out-of-doors,  and  I  should  have  liked  to  hear  somethint;  of  the  way  the 
girls  have  developed  that  part  of  their  plans  which  has  to  do  with  the  great  outdoors.  She  has  given 
you  the  ethical  and  educational  side  of  the  Camp  Fire  movement.  We  have  that  side  also  in  the  Boy 
Scout  movement,  but  I  confess  to  you  that  it  does  not  appeal  to  me  as  much  as  just  the  wholesome  side 
of  getting  the  boys  out  for  a  romp  in  the  open  air.  I  have  gone  into  It  with  a  great  deal  of  enthusiasm 
recently,  and  I  must  say  that  I  derive  considerable  pleasure  from  it.  I  get  from  it  the  opportunity  to 
indulge  in  the  same  sports  that  I  enjoyed  back  on  the  farm  at  home,  and  I  would  like  to  see  girls  doing 
the  same  sort  of  things  that  our  sisters  did  there.  Its  relation  to  infant  mortality  was  certainly  well 
brought  out  by  what  Mrs.  Gulick  has  said. 

I  believe  one  of  the  troubles  with  our  people  today  is  that  they  do  not  play  enough.  I  hope  I 
shall  never  lose  the  play  spirit.  I  like  to  skate  now  as  much  as  I  did  when  I  first  learned,  and  I  love  to 
go  swimming  with  my  boy  of  eight,  as  I  hope  I  will  with  my  baby  girl  of  a  few  months  when  she  is  a  little 
older.     I  believe  this  sort  of  thing  makes  us  better  fathers  and  better  mothers. 

I  think  there  is  another  side  of  the  relation  of  recreation  to  the  prevention  of  infant  mortality  that 
might  well  be  touched  upon  in  one  word.  I  had  hoped  to  be  able  to  show  a  lantern-slide  which  Miss 
Babbitt  brought,  and  which  she  showed  me.  It  represents  a  mother  with  a  baby  carriage  at  her  side, 
looking  wistfully  between  the  bars  of  a  fence  into  a  recreation  center.  The  suggestion  was  that  she  was 
shut  out.     There  did  not  seem  to  be  very  much  there  for  either  her  or  her  baby  to  do. 

What  shall  we  do  for  the  adult  who  wants  to  play?  Should  we  not  take  care  of  this  desire  when  we 
extend  our  playgrounds  movement?  .\  great  many  of  the  men  and  women  cannot  even  get  out  to  Fair- 
mount  Park  to  play.  The  playground  shown  in  the  picture  was  in  Chicago,  but  it  might  have  represented 
almost  any  city.  Yet  they  have  done  some  good  things  in  Chicago  along  this  line,  for  I  have  seen  in  that 
city  some  rest  stations  and  recreation  centers  which  had  space  for  the  baby  carriages,  and  something  for 
the  mothers  to  do,  and  some  of  the  big  playgrounds  in  Chicago  have  provided  very  admirably  for  the 
mothers'  need  of  recreation. 

I  would  particularly  like  to  see  something  done  for  the  j'oung  people  of  between  sixteen  and  twenty 
years  of  age.  The  girls  have  no  incentive  to  take  them  away  from  dance  halls  and  other  improper 
surroundings.  Now,  I  think  the  dance,  under  proper  condition,  is  wholesome.  I  enjoy  it  myself,  and 
would  like  to  see  the  right  opportunity  for  this  and  other  amusements  extended  to  our  young  women. 
We  should  not  be  ashamed  to  speak  of  play  or  to  engage  in  it,  for  we  adults  should  set  the  example  in 
these  matters. 

Mrs.  Wister:  I  feel  that  Mr.  Wilson's  advice  is  very  timely,  and  we  are 
obliged  to  him  for  it. 

In  bringing  the  Conference  to  a  close  I  wish,  on  behalf  of  the  managers  of  the 


264       REPORT  OF  THE  PHILADELPHIA  BABY  SAVING  SHOW 

Baby  Saving  Show,  to  extend  our  most  sincere  thanks  to  the  speakers  who  have 
been  good  enough  to  come  here  and  address  us.  I  am  sure  the  officers  are  extremely 
sorry  they  cannot  be  here  personally  to  deliver  this  message,  and  I  am  very  glad 
I  have  the  opportunity  of  doing  it  for  them.  It  is  a  privilege  to  have  listened  to 
these  addresses  and  discussions,  the  influence  of  which  goes  far  beyond  the  audiences 
we  have  had  in  this  room,  for  through  the  courtesy  of  the  public  press,  the  inspira- 
tion and  enlightenment  which  have  come  throughout  the  Conference  have  been 
extended  to  many  thousands  of  our  people  throughout  the  City  and  State,  and  I 
know  that  they,  too,  would  wish  to  express  their  gratitude  for  the  opportunity  which 
has  come  to  them. 


Index 


Index 


Abortion,  induced,  73 
Acrostics,  infectious  disease,  l.'ii 
Address  at  opening  of  Conference  on  Infant  Hy- 
giene, by  Mr.  Homer  Folks,  180 
Agriculture,  U.  S.  Department  of,  exhibit  of,  103 
Alcohol,  influence  of,  on  infant  mortality,  34 
Alphabet,  good  health,  153 
Artificial  feeding,  \ii 

cautions  for  mothers  and  nurses, 

125 
directions  regarding  milk  and  its 
preparation  for  the  baby,  123 
facts   which    the   mother   must 
note  to  report  to  the  doctor, 
125 
nipples  and  bottles,  123 
Attendance  at  main  exhibit,  103 

at  subsidiary  shows,  103 
Auxerre,  infant  milk  depots  in,  194 


B 

Baby,  care  of  the,  137 

Saving  Show,  committees.     See  CommiUees 

of  the  Baby  Saving  Shoic. 
Saving  Show,  rules  for  the  nursing  mother, 

133 
things  that  are  bad  for  the,  145 
Bad  booth,  145 

things  that  are  bad  for  the  baby,  145 

room  and  how  improved,  08,  09 

Baker,  S.  Josephine,  discussion  on   paper  by,  188 

S.  Josephine,  on  municipal  child  bureaus, 

182 

Blind,  New  York  Association  for.  Committee  for 

Prevention,  78 
Blindness,  prevention  of,  79,  81,  82 
Booth,  bad,  145 
Boston,  Committee  on  Childhood  Health  Exhibit 

of,  143 
Bottles  and  nipples,  123 
Breast  and  bottle  feeding,  relative  expense  of,  130 

feeding,  129 
Bureau  of  Chemistry,  U.  S.  Department  of  Agri- 
culture, exhiljit  of,  103 
of  Health,  Philadelphia,  Division  of  Bac- 
teriology, Laboratory  of  Hygiene,  83 
of  Health,  Philadelphia,  Division  of  Vital 

Statistics,  91 
of  Health,  Philadelphia,  exhibit  of,  83 


Care  of  the  baby,  137 
of  infants,  235 
19 


Care  of  milk  in  the  home,  107 

of  the  new  born.  75 
Cautions  for  mothers  and  nurses,  125 
Census,  Bureau  of  the,  U.  S.  Department  of  Com- 
merce and  Labor,  21 
Childhood  Health  Exhibit  of  Boston,  Committee 

on,  143 
Committee  on  Childhood  Health  Exhibit  of  Bos- 
ton, 143 
for  Prevention — N.  Y.  Association  for 
the  |{lind,  78 
Committees  of  the  Itaby  Saving  Show,  107 
Conmiittee  on  Education,  109 
Committee,  Executive,  Ui7 
Counuittee  on  Finance,  107 
Committee  on  General  .Arrangements, 

107 
Committee  on  Lectures  an<l  Demon- 
strations, 108 
Committee  on  Patronesses  and  Aides, 

109 
Committee    on    Procuring    Exhibits, 

l(i8 
Committee  on  I'ublication,  109 
Committee  on  Publicity,  108 
Committee  on   Social  Organizations, 

109 
and  organization,  107 
Communicable  diseases.  Bureau  of  Health,  Phila- 
delphia. 83 
diseases  other  than,  95 
Conference  on  Infant  Hygiene,  177 

on    Infant   Hygiene,   address   of   Mr. 

Homer  Folks  at  opening  of,  180 
on  Infant  Hygiene,  institutional  care  of 

infants,  235 
on   Infant   Hygiene,   consideration   of 
the   social   service  work  of  the  De- 
partment of  Diseases  of  Children  in 
the   Massachusetts  General   Hospi- 
tal, 204 
on   Infant   Hygiene,   control   of   mar- 
riages of  the  unfit,  221 
on    Infant    Hygiene,    education     for 

better  parenthood,  251 
on  Infant  Hygiene,  effect  of  housing 

upon  infant  mortality,  228 
on  Infant  Hygiene,  first  session,  179 
on  Infant  Hygiene,  Henry  Street  Set- 
tlement's  contribution   toward   the 
conservation   of   infant  health  and 
life,  241 
on  Infant  Hygiene,  infant  milk  depots, 

191 
on   Infant  Hygiene,   municipal  child 
bureaus,  182 


207 


268 


INDEX 


Conference  on  Infant  Hygiene,  prenatal  care  of 
infants,  245 
on  Infant  Hygiene,  proceedings  of,  179 
on  Infant  Hygiene,  regulation  of  mid- 
wifery, 213 
on  Infant  Hygiene,  second  session,  213 
on  Infant  Hygiene,  third  session,  234 
on  Infant  Hygiene,  value  of  recreation 
in  relation  to  infant  mortality,  258 
Conservation  of    infant  health  and    life,    Henry 

Street  Settlement's  contribution  toward,  241 
Consideration  of  the  social  service  work   of   the 
Department    of    Diseases    of    Children    in    the 
Massachusetts  General  Hospital,  204 
Contributors  to  the  Baby  Saving  Show,  list  of,  175 
Control  of  marriages  of  the  unfit,  221 


Daily  attendance  at  the  main  exhibit.  Horticul- 
tural Hall,  1G3 
Department  of  Health,  Pennsylvania  State,  25 

of  Public  Health  and  Charities,  Bur- 
eau of  Health,  Philadelphia,  83 
Diet  kitchen,  a  model,  82 
Directions  regarding  milk  and  its  preparation  for 

the  baby,  123 
Directory  and  Catalogue  of  Exhibits,  Charts,  Dia- 
grams, Signs,  and  Illustrations,  19 

and  Catalogue  of  Exhibits,  Bureau  of 
the  Census,  U.  S.  Department  of 
Commerce  and  Labor,  21 

and  Catalogue  of  Exhibits,  Bureau  of 
Health,  Philadelphia,  communicable 
diseases,  83 

and  Catalogue  of  Exhibits,  care  of  milk 
in  the  home,  107 

and  Catalogue  of  Exhibits,  care  of  the 
new  born,  75 

and  Catalogue  of  Exhibits,  Committee 
for  Prevention — N.  Y.  Association 
for  the  Blind,  78 

and  Catalogue  of  Exliibits,  conditions 
relating  to  maternal  environment  dur- 
ing pregnancy,  71 

and  Catalogue  of  Exhibits,  Department 
of  Public  Health  and  Charities,  Bur- 
eau of  Health,  Philadelphia,  83 

and  Catalogue  of  Exhibits,  diseases 
other  than  communicable,  95 

and  Catalogue  of  Exhibits,  exhibit  of 
the  Housing  Commission  of  Phila- 
delphia, 53 

and  Catalogue  of  Exhibits,  foods  and 
food  values,  113 

and  Catalogue  of  Exhibits,  Health  De- 
partment of  the  District  of  Columbia, 
95 

and  Catalogue  of  Exhibits,  hereditary 
syphilis,  30 

and  Catalogue  of  Exhibits,  heredity 
and  eugenics,  34 

and  Catalogue  of  Exhibits,  housing  and 
environment,  39 

and  Catalogue  of  Exhibits,  infant  feed- 
ing, 111 


Directory  and  Catalogue  of  Exhibits,  model  diet 
kitchen,  a,  82 
and    Catalogue    of   Exhibits,    Pennsyl- 
vania State  Department  of  Health, 
25 
and  Catalogue  of  Exhibits,  Philadelphia 
Hospital  for  Contagious  Diseases,  89 
and  Catalogue  of  Exhibits.  Philadelphia 
Pediatric  Society's  Milk  Commission, 
105 
and  Catalogue  of  Exhibits,  IJ.  S.  De- 
partment of  Agriculture,   Bureau  of 
Chemistry,  103 
and  Catalogue  of  Exhibits,  U.  S.  Pub- 
lic Health  and  Marine  Hospital  Ser- 
vice, 94 
and    Catalogue    of    Exhibits,    Visiting 
Nurse  Society,  Philadelphia,  61 
Diseases  other  than  communicable,  95 
District   of   Columbia,    Health   Department   of, 

exhibit  of,  95 
Division  of  Altai  Statistics,   Bureau  of  Health, 

Philadelphia,  exhibit  of,  91 
Down-town  subsidiary  shows,  lectures  and  speak- 
ers at,  161 

E 

Education,  Committee  on,  169 

for  better  parenthood,  251 

Effect  of  housing  upon  infant  mortality,  228 

Environment,  housing  and,  39 

Eugenics,  heredity  and,  34 

Executive  Committee,  167 

Exhibit  of  the  Housing  Commission,  Philadelphia, 
53 

Exhibits,  Charts,  Diagrams,  Signs,  and  Illustra- 
tions,  Directory   and    Catalogue    of, 
19.    See  Directory  and   Catalogue  of 
Exhibits. 
Committee  on  Procuring,  168 


Facts  which  the  mother  must  note  to  report  to 
the  doctor,  124 

Farrell,  Elizabeth  E.,  on  the  Henry  Street  Settle- 
ment's contribution  toward  the  conservation 
of  infant  health  and  life,  241 

Feeding,  artificial,  922 
breast,  129 

Finance,  Committee  on,  167 

Financial  statement,  173 

First  session  of  Conference  on  Infant  Hygiene,  179 

Fhes,  55 

Folks,  Mr.  Homer,  address  at  opening  of  Confer- 
ence on  Infant  Hygiene,  180 

Foods  and  food  values,  113 
patent,  149 

Freeman,  R.  G.,  discussion  on  paper  by,  201 
on  infant  milk  depots,  191 


General  Arrangements,  Committee  on,  167 
Gennantown  subsidiary  show,  lectures  and  speak- 
ers at,  162 


INDEX 


2G9 


Goddard,  Henry  H.,  on  control  of  marriages  of  the 
unfit,  ii\ 
discussion  on  paper  by,  2i3 
Good  health  alphabet.  153 
Guarantors  of  the  Baby  Saving  Show,  174 
GuUck,  Mrs.  Luther  H.,  discussion  on  paper  by, 
263 
Mrs.  Luther  H.,  on  the  value  of  recreation 
in  relation  to  infant  mortality,  258 

H 

Hart,  Hastings  H.,  on  institutional  care  of  infants, 

235 
Health  Department  of  the  District  of  Columbia, 

exhibit  of,  95 
Henry   Street   Settlement's   contribution   toward 

the  conservation  of  infant  health  and  life,  241 
Hereditary  syphili.s,  30 
Heredity  and  Eugenics,  34 

and    Eugenics,    effect    of   ill   health   of 

mother  on  infant  mortality,  35 
and  Eugenics,  effect  of  poverty  and  in- 
suflScient  food  on  infant  mortality,  36 
and  Eugenics,  mating  of  the  unfit,  .34 
Horticultural    Hall,    daily    attendance    at    main 
exhibit.  I(i3 
infants  cared  for  in  rest  room, 
163 
Hospitals  and  institutions,  154 
Hot  weather,  room  fitted  up  for  baby's  use  during, 

135 
House-flies,  85-89 
Housing  and  environment,  39 

Commission,  Philadelphia,  exhibit  of,  53 
Huntington,  James  L.,  discussion  on  paper  by,  219 
James  L.,  on  the  regulation  of  mid- 
wifery, 213 
Hygiene,  Infant,  proceedings  of  Conference  on,  179 


Induced  abortion,  73 
Infant  feeding.  111 

utensils  used  in,  111 

Hygiene,  Conference  on,  first  session  of,  179 

Conference  on,  proceedings  of,  179. 

See  Conference  on  Infant  Hygiene. 

Conference  on,  second  session  of,  213 

Conference  on,  third  session  of,  234 

milk  depots,  191 

in  Auxerre,  194 
in  New  York,  199,  200 
in  Pas-de-Calais,  192, 193 
in  Sens,  195 
in  St.  Pol-sur-Mer,  196 
in  ViUe  de  Toucy,  196 
in  Villeneuve-sur-Yonne,  197 
in  Yonkers,  198 
mortality,  effect  of  housing  upon,  228 

the   value   of  recreation  in  rela- 
tion to,  258 
Infants,  care  of,  235 

cared  for  in  rest  room.  Horticultural  Hall, 

163 
prenatal  care  of,  245 


Infectious  disease  acrostics,  152 
Influence  of  alcohol  on  infant  mortality,  34 
Institutional  care  of  infants,  235 
Institutions,  hospitals  and,  154 


Kensington  subsidiary  show,  lectures  and  speakers 

at,  162 
Kitchen,  a  model,  82 
a  plain,  127 


Lectures  and  Demonstrations,  Committee  on,  168 
and  siK-akers,  157 

at  the  subsidiary  .shows,  161 
at  Germantown  subsidiary 

.show,  162 
at    Kensington   subsidiary 

show,   102 
at    Manayunk    subsidiary 

show,  16.3 
in  Italian,  157 
in  Yiddish,  158 
Little  Mothers*  League  song,  259 


M 


dailv   attend- 


Main  exhibit.   Horticultural   Ha 

ance  at,  163 
Manayunk  subsidiary  show,  lectures  and  speakers 

at,  163 
Marriages  of  the  unfit,  control  of.  221 
Massachusetts  General   Hospital,   scheme   of   or- 
ganization of  Children's  Medical 
Out-patient  Department,  205 
General    Hospital,    social    service 
work  of  Department  of  Diseases 
of  Children,  204 
Maternal  environment   during  pregnancy,  condi- 
tions relating  to,  71 
Midwifery,  regulation  of,  213 
Milk  Corumission,  Philadelphia  Pediatric  Society's 
exhibit  of,  105 
directions  regarding  its  preparation  for  the 

baby,  123 
in  the  home,  care  of,  107 
Miscarriages,  effect  of,  on  infant  mortality,  73 

premature  births  and  still-births,  72 
prevention  of,  73 
Model  diet  kitchen,  a,  82 
Mothers  and  nurses,  cautions  for,  125 
Municipal  Child  Bureaus,  182 


N 
Neff,  Dr.  Joseph  S.,  213 
New  born,  care  of,  75 

New  York  Association  for  the  BUnd,  Committee 
for  Prevention,  78 
infant  milk  depots  in,  199,  200 
Nipples  and  bottles,  123 


270 


INDEX 


O 


Organization,  committees  and,  167 


Parenthood,  education  for  better,  251 
Pas-de-Calais,  infant  milk  depots  in,  192,  193 
Patent  foods,  149 

medicines  and  soothing  syrups,  147 
Patronesses  and  Aides,  Committee  on,  169 
Pennsylvania  State  Department  of  Health,  ex- 
hibit of,  25 
State   Livestock   Sanitary    Board, 
models  of  dairy  barns  from,  107 
Philadelphia,  Department  of  Public  Health  and 
Charities,  Bureau  of  Health,  ex- 
hibit of,  83 
Hospital  for  Contagious   Diseases, 

exhibit  of,  89 
Housing  Commission,  exhibit  of,  53 
Pediatric   Society's   Mlk   Commis- 
sion, exhibit  of,  105 
Pregnancy,   conditions   relating  to  maternal  en- 
vironment during,  71 
Premature  births  and  still-births,  miscarriages,  72 
Prenatal  care  of  infants,  245 
Proceedings  of  Conference  on  Infant  Hygiene,  177. 

See  ConSerence  on  Infant  Hygiene. 
Publication,  Committee  on,  169 
Publicity,  Committee  on,  168 
Putnam,  Dr.  Helen  C,  discussion  on  paper  by,  257 
Dr.   Helen  C.,  on  education  for  better 

parenthood,  251 
Mrs.  William  Lowell,  discussion  on  paper 

by, 249 
Mrs.  William  Lowell,  on  prenatal  care  of 
infants,  245 


R 

Recreation,  value  of,  in  relation  to  infant  mor- 
tality, 258 
Regulation  of  midwifery,  213 

Relative  expense  of  breast  and  bottle  feeding,  130 
Room  for  baby's  use  during  hot  weather,  135 
Rules  for  the  nursing  mother,  133 


Scheme  of  organization  of  Children's  Medical  Out- 
patient Department,  Massachusetts  General 
Hospital,  205 

Second  session  of  Conference  on  Infant  Hygiene, 
213 

Sens,  infant  milk  depots  in,  196 


Social  Organizations,  Committee  on,  169 

service  work   of  the  Department   of  Dis- 
eases of  Children,  Massachusetts  General 
Hospital,  204 
Soothing  syrups,  patent  medicines  and,  147 
Speakers  and  lectures,  157 
Statement,  financial,  173 
Stomach,  actual  size  of,  124 
St.  Pol-sur-Mer,  infant  milk  depots  in,  196 
Subsidiary  shows,  down-town,  161 

Germantown,  162 

Kensington,  162 

lectures  and  speakers  at,  161 

Manayimk,  163 

total  attendance,  163 
Syphilis,  hereditary,  30 


Talbot,  Fritz  B. 


Fritz  B. 


a  consideration  of  the  social 
service  work  of  the  Depart- 
ment of  Diseases  of  Children 
in  the  Massachusetts  General 
Hospital,  204 
discussion  on  paper  by,  ! 


Third  session  of  Conference  on  Infant  Hygiene,  234 


U 
Unfit,  control  of  marriages  of  the,  221 
United   States  Department  of  Agriculture,^Bu- 
reau  of  Chemistry,  exhibit  of, 
103 
Public  Health  and  Marine  Hos- 
pital Service,  exhibit  of,  94 
Utensils  used  in  infant  feeding.  111 


Value  of  recreation  in  relation  to  infant  mortality, 

258 
Values,  foods  and  food,  113 
Ville  de  Toucy,  infant  milk  depots  in,  196 
Villeneuve-sur-Yonne,  milk  depots  in,  197 
Visiting  Nurse  Society,  Philadelphia,  exhibit  of,  61 


w 

Wmslow,  C.  E.  A.,  discussion  on  paper  by,  231 
C.  E.  A.,  on  the  effect  of  housing  upon 
infant  mortality,  228 


Yonkers,  milk  depots  in,  198 


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